Bisphosphonate-related osteonecrosis of the jaw: an overview


  • Salvatore L. Ruggiero

    1. Department of Oral and Maxillofacial Surgery, School of Dental Medicine, SUNY at Stony Brook, Stony Brook, New York.
    2. Division of Oral and Maxillofacial Surgery, Long Island Jewish Medical Center, New Hyde Park, New York
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Address for correspondence: Salvatore L. Ruggiero, New York Center for Orthognathic and Maxillofacial Surgery, 2001 Marcus Avenue, Suite N10, Lake Success, NY 11040.


Bisphosphonates are widely used in the management of metastatic disease to bone and in diseases of altered bone turnover. Recently, multiple-case series and retrospective studies have established a relationship between necrotic bone lesions localized to the jaw and the use of chronic bisphosphonate therapy. This condition has been named bisphosphonate-related osteonecrosis of the jaw (BRONJ). To evaluate the potential risks associated with this new and emerging complication, stage-specific management strategies and guidelines have been developed. In view of the widespread use of chronic bisphosphonate therapy, the observation of an associated risk of osteonecrosis of the jaw should alert practitioners to monitor for this previously unrecognized complication and to reevaluate the indications for and the duration of bisphosphonate therapy in patients with osteopenia/osteoporosis and cancer. Morbidity associated with BRONJ might be prevented or reduced by implementing prevention strategies and establishing early diagnostic procedures. The current widespread use of bisphosphonates as an inhibitor of bone resorption is directly attributable to their efficacy in improving the quality of life for patients with metastatic bone cancer, osteoporosis, and Paget's disease.