Bisphosphonate-related osteonecrosis of the jaw in non-malignant bone disease

Bisphosphonates such as alendronate, risedronate and zoledronate have revolutionised the treatment for osteoporosis and Paget’s disease. These drugs reduce fracture risk and probably mortality in patients with osteoporosis. However, they have a long in vivo half-life following cessation and may be associated with delayed dental healing and even the devastating complication of osteonecrosis of the jaw (ONJ). Extensive media attention highlighting this issue has caused much concern among patients and healthcare professionals. This paper seeks to provide treating clinicians with a balanced multi-disciplinary review of the available evidence pertaining to this issue and practical advice regarding prevention and management of ONJ.