Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ)

Bisphosphonate therapy— used primarily in the treatment of osteoporosis and cancer-related conditions—carries a risk of bisphosphonate-related osteonecrosis of the jaws (BRONJ). In 2003-2004, the first cases of non-healing, exposed, necrotic bone in the jaws of patients treated with i.v. bisphosphonates were reported.1,2 In subsequent years further cases were identified, and in 2006, the American Association of Oral and Maxillofacial Surgeons published a position paper on this topic.3 The following is a summary of their report.

BRONJ Diagnosis

BRONJ may be diagnosed if patients demonstrate: current or previous treatment with a bisphosphonate; exposed bone in the maxillofacial region persisting more than eight weeks; and no history of radiation therapy to the jaws.3

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My Analysis: Many WG patients who have been on prednisone for any length of time have problems with oesteoporosis. Fosomax and other Bisphosphonates are used to help build bones. As one of the patients on our discussion groups said, "Just another thing to worry about."

Osteonecrosis of the Jaw
Bone under the teeth is exposed, often painfully
Swelling and loosening of teeth may be seen
Attempts at surgical correction make lesions worse
Most cases follow dental procedure such as tooth extraction
Many cases are complicated by infection