Bisphosphonates and osteonecrosis. Medical search. Frequent questions

Necrotic jaws or other maxillofacial skeleton necrosis associated with bisphosphonate use (see BISPHOSPHONATES). (childrensmercy.org)
For patients taking oral biphosphonates, the two factors that significantly increase the risk of developing osteonecrosis of the jaws are, the duration of continuous oral biphosphonate therapy: treatment of 3 years or more is associated with progressively increased risk, and concomitant use of steroids, particularly prednisone. (blumnico.com)
Osteonecrosis of the jaw (ONJ) is a severe bone disease (osteonecrosis) that affects the jaws (the maxilla and the mandible). (wikipedia.org)
The bisphosphonate related osteonecrosis of the jaws (BRONJ) is defined as a drug-adverse reaction that involves the maxillary bones. (peertechzpublications.com)
The clinical pattern was described for the first time by Marx RE in 2003, who observed the development of jaws osteonecrosis in patients underwent to Multiple Myeloma and Mammary Cancer therapy [2]. (peertechzpublications.com)
Bisphosphonates (BPs), the antiresorptive drugs , can cause osteonecrosis of the jaws . (bvsalud.org)
Summary: The administration of teriparatide (TPTD) in conjunction with periodontal care could provide faster and more favorable clinical outcomes in previously refractory bisphosphonate-related osteonecrosis of the jaws (BRONJ) cases compared to conventional dental care, combination of surgery and antimicrobial treatment. (elsevierpure.com)
The jaws are particularly sensitive to osteonecrosis due to high bone turnover resulting from daily activity and the presence of teeth 1 . (medsafe.govt.nz)
Patients may be considered to have bisphosphonaterelated ONJ if they have current or previous treatment with a bisphosphonate and have exposed or necrotic bone in the maxillofacial region that has persisted for more than eight weeks with no history of radiation therapy to the jaws 2 . (medsafe.govt.nz)
We selected the following preferred terms: osteonecrosis of the jaws, osteonecrosis, osteomyelitis. (bmj.com)
The clinical patterns of adverse drug reactions of the oral cavity include xerostomia, swelling, nonspecific ulceration, vesiculobullous or ulcerative mucositis that mimics other disease states, nonspecific vesiculoulcerative mucositis, pigmentation, gingival enlargement, and medication-related osteonecrosis of the jaws. (medscape.com)
Prediction of medication-related osteonecrosis of the jaws using machine learning methods from estrogen receptor 1 polymorphisms and clinical information. (cdc.gov)

We present a case of non-surgically managed bilateral osteonecrosis of the external auditory canal with a history of long-term medical therapy for osteoporosis. (bmj.com)
Osteoporosis is increasing in prevalence alongside an ageing population and oral bisphosphonates are the recommended first-line antiresorptive therapy. (bmj.com)
The bisphosphonates (BFs) are synthetic drugs used to treat multiple myeloma, bone pathologies associated with malignancy, Paget's disease and osteoporosis. (bvsalud.org)
Bisphosphonates are drugs that help prevent or slow down bone thinning (osteoporosis). (cancerresearchuk.org)
4 Nonsystematic reviews suggest that it occurs in up to 20% of patients with cancer who receive intravenous bisphosphonates, but in only about 0.04% of patients with osteoporosis who receive oral bisphosphonates. (aafp.org)
6 A 2007 systematic review of eight case reports or case series and three retrospective studies included 26 patients with osteonecrosis of the jaw who were taking bisphosphonates for osteoporosis. (aafp.org)
Evidence is insufficient to confirm a causal link between low-dose bisphosphonate use in osteoporosis with osteonecrosis of the jaw. (medscape.com)
The possible risk from lower oral doses of bisphosphonates, taken by patients to prevent or treat osteoporosis, remains uncertain. (wikipedia.org)
Because of occurring osteoporosis, the patient underwent to bisphosphonates administration. (peertechzpublications.com)
As of yet, there is no cure for osteoporosis, and the most frequent and cost efficient pharmacological treatments include hormone replacement or inhibition of osteoclast activity via bisphosphonates ( Tella and Gallagher, 2014 ). (frontiersin.org)
CHICAGO -- While the widely reported adverse effects of long-term bisphosphonate treatment in osteoporosis patients are certainly real, undertreatment of fracture risk now appears to be gaining, a prominent rheumatologist warned in a lecture here. (medpagetoday.com)
Speaking at the American College of Rheumatology's 2018 State of the Art Symposium, Saag said that bisphosphonate "sabbaticals" may cut the risk of osteonecrosis and atypical fractures known to be associated with these agents -- but that substituting alternative drugs may be preferable to stopping all osteoporosis medications. (medpagetoday.com)
Bisphosphonates are a group of medicines used to treat osteopenia or osteoporosis, which are conditions associated with thin or fragile bones that are at increased risk for fracture. (rheumatology.org)
Use of most popular osteoporosis medications are associated with brittle bones, osteonecrosis, heart damage and cancer. (holtorfmed.com)
Bisphosphonates such as Fosamax, Acetenol, Reclast, and Boniva are widely used to treat osteoporosis. (holtorfmed.com)

The incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) has been strongly correlated with the aminobisphosphonates pamidronate (Aredia) and zoledronic acid (Zometa) and is even higher in patients who have had recent dental extractions. (medscape.com)
A blinded review of adverse events from five randomized controlled trials (11,608 participants) comparing zoledronic acid (Reclast) with placebo or another bisphosphonate found one case of osteonecrosis in the zoledronic acid group and one in the control group. (aafp.org)
In a literature review of case reports, the minimum onset time was 10 months with zoledronic acid, 18 months with pamidronic acid and three years with oral bisphosphonate treatment 6 . (medsafe.govt.nz)
The average cumulative minimum dose prior to diagnosis was 49mg for zoledronic acid, 2,217mg for pamidronic acid and 13,870mg for oral bisphosphonates 6 . (medsafe.govt.nz)
In 98% (671) of the reports the suspect drug is at least one bisphosphonate (BP) (zoledronic acid in 74.5%) and 67.5% of the reports come from 10, mainly academic, health structures. (bmj.com)
The risk of zoledronic acid causing osteonecrosis of the jaw in people with cancer in their bones, the study found, is about 1% after a year of being on the drug, 2% after 2 years, and 3% after 3 years. (cancer.gov)
The study results, published December 17 in JAMA Oncology , also showed that people who received the same dose of zoledronic acid more frequently had a greater risk of developing osteonecrosis of the jaw. (cancer.gov)
This is one of the first studies to systematically evaluate dental health and the risk for developing osteonecrosis of the jaw with zoledronic acid," said Lori Minasian, M.D., deputy director of NCI's Division of Cancer Prevention , who helped facilitate the study but was not a study investigator. (cancer.gov)
Zoledronic acid and similar drugs, known as bisphosphonates , interfere with the breakdown of bone tissue that results when cancer cells grow in the bone. (cancer.gov)
To assess the risk of osteonecrosis of the jaw in people with cancer, the SWOG study team, which included dental specialists as well as cancer researchers, enrolled 3,491 patients who were planning to receive zoledronic acid for metastatic bone cancer. (cancer.gov)
In addition, patients who received more total doses of zoledronic acid within the first year of treatment (or longer) were more likely to develop osteonecrosis of the jaw than those who received fewer doses. (cancer.gov)

For example, optimizing dental health before starting treatment can prevent osteonecrosis of the jaw, or at least the clinical problems stemming from it. (medpagetoday.com)
How can I prevent osteonecrosis of the jaw? (msdmanuals.com)

A rare side effect of bisphosphonate treatment is osteonecrosis of the jaw. (cancerresearchuk.org)
Bisphosphonate related osteonecrosis of the jaw (BRONJ) is a recently described adverse side effect of bisphosphonate therapy, with an estimated 94% of cases reported in the oncologic patients receiving intravenous nitrogen-containing bisphosphonates (BP). (ca.gov)

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a condition found in patients who have received intravenous and oral forms of bisphosphonate therapy for various bone-related conditions. (medscape.com)
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is thought to be caused by trauma to dentoalveolar structures that have a limited capacity for bone healing due to the effects of bisphosphonate therapy. (medscape.com)
Several studies of patients with multiple myeloma and patients with breast cancer who received intravenous aminobisphosphonate therapy for metastatic bone lesions demonstrated 6-11% of the patients developed bisphosphonate-related osteonecrosis of the jaw (BRONJ). (medscape.com)
10 years of once weekly bisphosphonate therapy before switching to denosumab. (bmj.com)
Physicians should discontinue bisphosphonate therapy in patients who have had a femoral shaft fracture or osteonecrosis of the jaw, and should consider discontinuing bisphosphonate therapy after three to five years in patients with low fracture risk. (aafp.org)
A nested case-control study from Canada matched 716 women 79 to 88 years of age who sustained a subtrochanteric or femoral shaft fracture after receiving bisphosphonate therapy with 3,580 control patients who did not have fractures. (aafp.org)
Researchers compared bisphosphonate use and duration of therapy in these groups and in 200 patients older than 50 years who did not have fractures. (aafp.org)
Osteonecrosis of the jaw associated with bisphosphonate therapy, which is required by some cancer treatment regimens, has been identified and defined as a pathological entity (bisphosphonate-associated osteonecrosis of the jaw) since 2003. (wikipedia.org)
A thorough history and assessment of pre-existing systemic problems and possible sites of dental infection are required to help prevent the condition, especially if bisphosphonate therapy is considered. (wikipedia.org)
It develops during or after a long-term bisphosphonate therapy in absence of radiotherapy [1]. (peertechzpublications.com)
Oral infection is considered to play a critical role in the pathogenesis of bisphosphonate-related osteonecrosis of the jaw (BRONJ), and antibiotic therapy has become a mainstay of BRONJ therapy. (nih.gov)
Saag noted that, at the outset of bisphosphonate therapy, steps can be taken to reduce some of the risks. (medpagetoday.com)
He cited 2011 data indicating that, for bisphosphonate therapy, the number needed to harm for atypical fracture was 417 over 3 years, whereas the number needed to treat for osteoporotic hip and vertebral fracture was 91 and 14, respectively. (medpagetoday.com)
He proposed bisphosphonate "sabbaticals," defined as an extended stoppage of therapy, as opposed to the more traditional "holiday" concept, for patients found to be at risk for adverse bisphosphonate effects and yet still at risk for osteoporotic fractures. (medpagetoday.com)
If undergoing an invasive procedure of the jaw (tooth extraction) or a history of malignancy and/or dental infections while on bisphosphonate therapy. (rheumatology.org)
Atypical fractures of the femur have been associated with long-term bisphosphonate therapy. (rheumatology.org)
Before beginning IV bisphosphonate therapy, have a dental examination and get any oral surgery you need done first. (msdmanuals.com)

In patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ), panoramic and plain radiography of the mandible reveal areas of sclerosis, destruction, sequestration, or pathologic fractures. (medscape.com)
Bisphosphonates are associated with a small risk of atypical femoral shaft fractures, which increases with duration of use. (aafp.org)
However, the odds ratio for a classic fracture was 0.5 (95% CI, 0.3 to 0.9), suggesting a 50% reduction in these types of fractures in women receiving bisphosphonates. (aafp.org)
In 2010, the American Society of Bone and Mineral Research Femoral Fracture Task Force recommended that US health regulators rewrite the warning labels for bisphosphonates because of their possible association with atypical femur fractures. (yourlawyer.com)
In conducting the study, the task force looked at 310 cases of atypical femur fractures and found that in the majority of cases (291), the patients had been taking bisphosphonates. (yourlawyer.com)
The previous March, the FDA announced it was reviewing bisphosphonates for a possible link to atypical subtrochanteric femur fractures in some patients who had been on the drugs for several years. (yourlawyer.com)
By now, the risks associated with bisphosphonates when continued for many years are well known to all physicians: femoral fractures and others considered atypical in the senior population, and osteonecrosis of the jaw. (medpagetoday.com)
With respect to atypical fractures, Saag said a point to bear in mind is that the risk remains well below that for the osteoporotic fractures that bisphosphonate prevent. (medpagetoday.com)
These have shown strong effects in promoting bone mineral density without risk of atypical fractures or jaw osteonecrosis. (medpagetoday.com)
Like bisphosphonates, it inhibits bone resorption (rather than promoting bone formation) and has been tied to osteonecrosis and atypical fractures, though at relatively low rates. (medpagetoday.com)
In women with osteopenia, bisphosphonates are shown to prevent bone loss, and physicians prescribe them with the hope of preventing future fractures. (holtorfmed.com)

The 2014 update of a position paper from the American Association of Oral and Maxillofacial Surgeons (AAOMS) recommended changing the name of bisphosphonate-related osteonecrosis of the jaw (BRONJ) to medication-related osteonecrosis of the jaw (MRONJ), owing to the increased number of maxillary and mandibular osteonecrosis cases that have been linked to other antiresorptive (denosumab) or antiangiogenic treatments. (medscape.com)
We report the first case of bilateral osteonecrosis of the external auditory canal associated with denosumab and bisphosphonates with successful conservative management. (bmj.com)

As for the ONJ risk factors, Dr. Bilezikian states: 'Predisposing factors for the development of osteonecrosis of the jaw appear to be dental disease, dental surgery (e.g., tooth extraction), oral trauma, periodontitis, and poor dental hygiene. (drug-injury.com)

The AAOMS's 2022 update to its position paper on medication-related osteonecrosis of the jaw (MRONJ) lists medication families that have been implicated as risk factors for the condition since the 2014 update. (medscape.com)
The symptoms of this are very similar to the symptoms of medication-related osteonecrosis of the jaw (MRONJ). (wikipedia.org)

As potent inhibitors of osteoclast activity, the nitrogen-containing bisphosphonates might retard skeletal repair processes associated with trauma to or infection of the oral mucosa that involves the underlying bone. (drug-injury.com)
Other potential mechanisms include the possible antiangiogenic effects of nitrogen-containing bisphosphonates and the effects of these agents on T-cell function. (drug-injury.com)

An increased incidence of ONJ has been associated with the use of high dosages of bisphosphonates required by some cancer treatment regimens. (yourlawyer.com)

5% of patients with SLE will develop osteonecrosis. (slideserve.com)
Current smokers were about twice as likely to develop osteonecrosis of the jaw as former or never smokers. (cancer.gov)

By December 2006, 3607 cases of people with this ADR had been reported to the FDA and 2227 cases had been reported to the manufacturer of intravenous bisphosphonates. (wikipedia.org)

Bisphosphonate medications include alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva). (rheumatology.org)
A recent study of over 13,000 patients by researchers at the University of California School of Dentistry and published in the Journal of the American Dental Association found that 1 out 25 patients taking Fosamax (alendronate) suffered from osteonecrosis of the jaw while no cases were found among patients without a history of Fosamax use. (holtorfmed.com)

As reported previously, there is increasing attention being paid to the association between the use of oral bisphosphonates and osteonecrosis of the jaw (ONJ) , the serious side effect which is commonly called jawbone death, bone decay, or jaw rot. (drug-injury.com)
Although spontaneous osteonecrosis is reported in a minority of cases, the majority of patients give a history of some prior dental or oral surgical manipulation. (drug-injury.com)
Biphosphonate related osteonecrosis of the jaw, (BRON), is a pathological condition that is defined as oral bone exposure for a period greater than 8 weeks, in a patient that has been on biphosphonate medication without a history of exposure to external beam radiation. (blumnico.com)
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a condition in which bones of the maxillofacial skeleton, in particular the tooth-bearing areas, become necrotic and exposed to the oral cavity. (medscape.com)
The first three reported cases of bisphosphonate-associated osteonecrosis of the jaw were spontaneously reported to the FDA by an oral surgeon in 2002, with the toxicity being described as a potentially late toxicity of chemotherapy. (wikipedia.org)
In 2003 and 2004, three oral surgeons independently reported to the FDA information on 104 cancer patients with bisphosphonate-associated osteonecrosis of the jaw seen in their referral practices in California, Florida, and New York. (wikipedia.org)
The incidence of ONJ associated with oral bisphosphonate treatment is much lower, possibly in the region of one in 60 thousand 5 . (medsafe.govt.nz)
In 2003, oral surgeons first noticed that some patients receiving bisphosphonates were developing osteonecrosis of the jaw-a condition rarely seen before then. (cancer.gov)
Dr. Sedghizadeh DDS, the lead researcher of this study states, "We've been told that the risk with oral bisphosphonates is negligible, but it is not negligible. (holtorfmed.com)
Your dentist or oral surgeon can tell whether you have osteonecrosis of the jaw based on your symptoms and an exam. (msdmanuals.com)

These drugs have a number of side effects, and a new complication known as biphosphonate-associated osteonecrosis (BaO) was recently identified. (bvsalud.org)
Although BRON appear to be a potential complication with bisphosphonates , it should not preclude its use when clinically indicated. (blumnico.com)

Bisphosphonates (BF) pharmacokinetics consist in the osteoclast function interruption, angiogenesis inhibition, as well as blocking any cancer cell line activity together with the interruption of signal transduction [3]. (peertechzpublications.com)

Two recent medical journal articles provide information about how osteonecrosis of the jaw (ONJ) may be caused by Fosamax and other bisphosphonates as well as identify some of the predisposing, or risk, factors for developing ONJ. (drug-injury.com)
This includes a large study of 1700 women published in Archives of Internal Medicine that demonstrated that current and past users of bisphosphonate medication such as Fosamax, Actonel, Reclast, and Boniva had significantly increased risk of potentially fatal heart arrhythmias. (holtorfmed.com)

Bone brittleness and fracture risk increase with increasing duration of bisphosphonate use even if bone density continually improves. (holtorfmed.com)

Several investigators have identified increasing duration of exposure, type of bisphosphonate, older age and prior history of a dental procedure as risk factors for the development of ONJ. (drug-injury.com)
2-4 An increased risk of developing osteonecrosis is associated with intravenous administration or when treatment is sustained over 3-5 years. (bmj.com)
Bisphosphonates are associated with a small risk of osteonecrosis of the jaw, which is more common in patients who are older, female, or have poor dental hygiene or cancer. (aafp.org)
The authors calculated that the relative risk for atypical fracture in women receiving bisphosphonates was 47.5 (95% CI, 25.6 to 87.3). (aafp.org)
2011. Epidemiology and risk factors for osteonecrosis of the jaw in cancer patients. (medsafe.govt.nz)
2006. Osteonecrosis of the jaw and bisphosphonates-putting the risk in perspective. (medsafe.govt.nz)
The NCI-funded study, run by the SWOG Cancer Research Network, also found that poor dental health and smoking were risk factors for developing osteonecrosis of the jaw in these patients. (cancer.gov)
And patients can also play a role in reducing the risk of osteonecrosis of the jaw, Dr. Minasian said. (cancer.gov)
Bisphosphonates work by reducing the turnover of bone which lowers the risk of fracture. (rheumatology.org)
There is a rare risk of developing damage to the cells within the bones of the jaw called osteonecrosis. (rheumatology.org)
Note: These drugs increase the risk of developing osteonecrosis of the jaw (ONJ). (lls.org)
There are a number of studies that demonstrate that the use of bisphosphonates is associated with an increased risk of heart arrhythmias. (holtorfmed.com)
Taking them this way doesn't seem to increase risk of osteonecrosis of the jaw. (msdmanuals.com)

The authors evaluated prescription data and found that of 52,595 women receiving bisphosphonates for more than five years, only 71 (0.13%) sustained an atypical fracture. (aafp.org)
After adjusting for sex and for corticosteroid and vitamin D use, the use of bisphosphonates was associated with an odds ratio of 49.7 for an atypical fracture compared with the no-fracture group (95% CI, 15.9 to 155.1). (aafp.org)

2011. A review of the clinical implications of bisphosphonates in dentistry. (medsafe.govt.nz)

Osteonecrosis: etiology, diagnosis, and treatment. (slideserve.com)

Since the jawbones are in constant use and are characterized by active remodeling, bisphosphonates might accumulate there preferentially, resulting in concentrations that exceed those found elsewhere in the skeleton. (drug-injury.com)
This is less of an issue with bisphosphonates, which accumulate in bone and are actually re-released into the circulation at pharmacologically active levels (perhaps contributing to their adverse effects). (medpagetoday.com)

The brittle bones caused by bisphosphonates use is not limited to the jaw. (holtorfmed.com)

Pain and neuropathy Erythema and suppuration Bad breath Post radiation maxillary bone osteonecrosis is something that is found more in the lower jaw (mandible) rather than the maxilla (upper jaw) this is because there are many more blood vessels in the upper jaw. (wikipedia.org)
CT scan showing osteonecrosis of the lower jaw with an arrow pointing to a fracture. (cancer.gov)

The fracture toughness of small animal cortical bone measured using arc-shaped tension specimens: Effects of bisphosphonate and deproteinization treatments. (iu.edu)

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) manifests as exposed, nonvital bone involving the maxillofacial structures. (medscape.com)

What are the risks of bisphosphonate use? (aafp.org)
Despite the association of these medicines with ONJ, the benefits of bisphosphonate treatment are still considered to outweigh the risks of experiencing this condition. (medsafe.govt.nz)

The estimated incidence of osteonecrosis of the jaw is 1 to 10 per 100,000 patient-treatment years. (aafp.org)
He credited the ACP guideline with highlighting the need for awareness of bisphosphonates' adverse effects and the concept of interrupting treatment. (medpagetoday.com)

A patient that has osteonecrosis may also be susceptible to bacterial and fungal infections. (wikipedia.org)
Clearing the Patient on Bisphosphonates for Dental Procedures: When Should You Do It? (medscape.com)

In part two of this series, sub-titled 'What Patients Should Know About The Signs And Symptoms As Well As Diagnostic Staging' , we get from these same two medical journal articles some important information about the early signs and symptoms of osteonecrosis of the jaw (ONJ) as well as the extent, or staging, of ONJ upon diagnosis. (drug-injury.com)

Bisphosphonates are believed to bind to osteoclasts and interfere with bone remodeling. (medscape.com)

Bisphosphonate induced and radiation induced osteonecrosis can also have an apparently destructive appearance. (bmj.com)

Osteonecrosis of the jaw is primarily associated with high-dose bisphosphonate use in cancer patients. (medscape.com)
citation needed] The International Myeloma Foundation's web-based survey included 1203 respondents, 904 patients with myeloma and 299 with breast cancer and an estimate that after 36 months, osteonecrosis of the jaw had been diagnosed in 10% of 211 patients on zoledronate and 4% of 413 on pamidronate. (wikipedia.org)
Bisphosphonate-induced ONJ is estimated at 0.1% for patients with cancer being treated for associated bone problems that have not had invasive dental procedures 4 . (medsafe.govt.nz)
In September 2010, a study published in the British Medical Journal raised questions about a possible link between long-term use of bisphosphonates and cancer of the esophagus. (yourlawyer.com)
Another 31 cases of the cancer were reported among bisphosphonate users in Europe and Japan. (yourlawyer.com)
Since then, several more cases of esophageal cancer associated with bisphosphonate use have been reported to the FDA, bringing the total to 34. (yourlawyer.com)

Use of these medications for more than a few years is associated with inability to repair and heal even micro-cracks that occur with normal daily activities and is associated with osteonecrosis (disintegration of the excessively brittle bone). (holtorfmed.com)

The true incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) has yet to be determined. (medscape.com)
Data that links the incidence of osteonecrosis of the jaw and its etiologic factors are limited, and the incidence of osteonecrosis of the jaw in the general population (ie, those not taking bisphosphonates) is unknown. (medscape.com)

Osteonecrosis of the Jaw (ONJ) has been associated with a number of medicines and is a potentially debilitating condition that is difficult to treat. (medsafe.govt.nz)

Osteonecrosis is, in many cases, subsequent to a dental extraction [7,18] or to other conditions which implicate bone remodeling. (peertechzpublications.com)

What are the symptoms of osteonecrosis of the jaw? (msdmanuals.com)

Necrotising otitis externa, cholesteatoma and malignancy were considered but with histology, microbiological and CT assessment, bilateral osteonecrosis of the external auditory canal was diagnosed. (bmj.com)

Anatomy19

Organisms1

Diseases34

Chemicals and Drugs25

Analytical, Diagnostic and Therapeutic Techniques and Equipment26

Psychiatry and Psychology1

Phenomena and Processes14

Technology, Industry, Agriculture1

Information Science1

Health Care5

Jaws12

Osteoporosis15

Zoledronic acid11

Prevent osteonecrosis of2

Side effect of bisphosphonate2

Therapy17

Fractures11

Denosumab2

Development of osteonecrosis1

Medication-related osteonecrosis2

Nitrogen-containing bisp2

Required by some cancer treatment regimens1

Develop osteonecrosis2

Intravenous bisphosphonates1

Alendronate2

Oral10

Complication2

Osteoclast1

Fosamax2

Fracture risk1

Risk13

Atypical fracture2

Dentistry1

Etiology1

Accumulate2

Bones1

Lower jaw2

Treatments1

Maxillofacial1

Risks2

Treatment2

Patient2

Diagnostic1

Interfere1

Radiation1

Cancer6

Medications1

Incidence2

Medicines1

Cases1

Symptoms1

Malignancy1