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Consensus practice guidelines for bisphosphonate-associated osteonecrosis of the jaw

Nature Clinical Practice Rheumatology volume 5, pages 6–7 (2009)Cite this article

Bisphosphonates are widely used in the management of a number of benign (e.g. osteoporosis, Paget disease) and malignant (e.g. multiple myeloma) bone diseases. Importantly, the dosages used in osteoporosis and Paget disease are generally an order of magnitude less than those used in an oncology setting. In 2003, reports began to emerge of a serious bone disorder—subsequently labeled osteonecrosis of the jaw (ONJ)—in patients undergoing bisphosphonate therapy.1,2,3 Following warnings from the pharmaceutical industry, regulatory authorities in many countries issued recommendations to modify bisphosphonate product information. Subsequent reports in the medical and dental literature, as well as in the general media, were often alarmist and misleading, especially in failing to discriminate between the different doses of bisphosphonates used in specific clinical settings. This misinformation has led many patients to discontinue therapy for conditions such as osteoporosis, with probable adverse consequences.4

A variety of criteria have been used in the literature to diagnose ONJ. In 2006, however, a multidisciplinary task force appointed by the American Society for Bone and Mineral Research proposed a working definition of ONJ: an area of exposed bone—typically the mandible, maxilla or both—that persists for more than 8 weeks in the absence of previous radiation and/or metastasis in the jaw.5

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  1. Kolling Institute, Royal North Shore Hospital, Level 4, Building 35, St Leonards 2065, Sydney, Australia sambrook@med.usyd.edu.au

Authors and Affiliations

  1. PN Sambrook is a Professor of Rheumatology at the Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, Australia.,

    Philip N Sambrook

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  1. Philip N Sambrook
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Sambrook, P. Consensus practice guidelines for bisphosphonate-associated osteonecrosis of the jaw. Nat Rev Rheumatol 5, 6–7 (2009). https://doi.org/10.1038/ncprheum0960

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