Osteoporosis International

, Volume 18, Issue 10, pp 1363–1370 | Cite as

Osteonecrosis of the jaw induced by orally administered bisphosphonates: incidence, clinical features, predisposing factors and treatment outcome

  • N. YaromEmail author
  • R. Yahalom
  • Y. Shoshani
  • W. Hamed
  • E. Regev
  • S. Elad
Original Article



Osteonecrosis of the jaw (ONJ) is a well-known devastating side effect of bisphosphonate therapy for cancer. Several ONJ cases of patients using oral bisphosphonates have been reported in the literature. The present study analyzed the clinical features, predisposing factors, and treatment outcome of 11 patients with oral bisphosphonates-related ONJ.

Introduction and hypothesis

Osteonecrosis of the jaw (ONJ) is a well-known side effect of parenteral bisphosphonates therapy. Although ONJ has been reported in patients using oral bisphosphonates, documentation of this entity is sparse. It was hypothesized that the clinical features, predisposing factors, and treatment outcome of this population are different from those of oncologic patients.


This retrospective bi-central study involved 98 ONJ patients, 13 of whom were treated with oral bisphosphonates. Two patients were excluded because of previous use of intravenous bisphosphonates. The profiles of 11 patients were analyzed.


The mean duration of alendronate use before developing ONJ was 4.1 years. ONJ was triggered by dental surgery in 9 patients and by ill-fitted dentures in 2. Heavy smokers were the most recalcitrant subjects. Among the nine patients with at least 6 months of follow-up, ONJ healed completely in three, partially in four, and not at all in two.


ONJ is a rare devastating side effect of oral bisphosphonates associated with patient morbidity and high financial burden. Clinicians must be aware of this entity and inform patients of the risks of dental surgery. The synergistic effect of smoking in the pathogenesis of ONJ should be further investigated.


Alendronate Bisphosphonate Jaws Osteomyelitis Osteonecrosis Osteoporosis 



The authors would like to thank Ms. Rita Lazar and Ms. Esther Eshkol for editorial assistance.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2007

Authors and Affiliations

  • N. Yarom
    • 1
    • 2
    Email author
  • R. Yahalom
    • 2
  • Y. Shoshani
    • 2
  • W. Hamed
    • 3
  • E. Regev
    • 4
  • S. Elad
    • 3
  1. 1.Department of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental MedicineTel Aviv UniversityTel AvivIsrael
  2. 2.Department of Oral and Maxillofacial Surgery“Sheba” Medical CenterTel-HashomerIsrael
  3. 3.Department of Oral MedicineHebrew University-Hadassah School of Dental MedicineJerusalemIsrael
  4. 4.Department of Oral and Maxillofacial SurgeryHebrew University-Hadassah School of Dental MedicineJerusalemIsrael

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