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

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Abstract

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.

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Conflict of interest

PKKW has received speaking honoraria, travel support or unrestricted research grants from Amgen, Eli Lilly, Sanofi-Aventis, Novartis and Servier. JDW has received speaking honoraria, travel support or unrestricted research grants from Amgen, Eli Lilly, GSK, Merck Sharpe and Dohme, Novartis, Sanofi-Aventis and Servier. He has served on advisory boards for Amgen/GSK and Novartis. Specifically, Novartis has provided an unrestricted grant to the authors to conduct a case–control study of delayed dental healing in patients on BPs. GB has no other competing interests.

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Authors and Affiliations

  1. Mid-North Coast Arthritis Clinic, PO Box 6307, Coffs Harbour, NSW, 2450, Australia

    Peter K. Wong

  2. Rural Clinical School, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia

    Peter K. Wong

  3. Melbourne Dental School, The University of Melbourne, Parkville, Melbourne, VIC, Australia

    Gelsomina L. Borromeo

  4. Department of Medicine, University of Melbourne and Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Melbourne, VIC, Australia

    John D. Wark

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  1. Peter K. Wong
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  2. Gelsomina L. Borromeo
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  3. John D. Wark
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Correspondence to Peter K. Wong.

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Wong, P.K., Borromeo, G.L. & Wark, J.D. Bisphosphonate-related osteonecrosis of the jaw in non-malignant bone disease. Rheumatol Int 33, 2189–2198 (2013). https://doi.org/10.1007/s00296-013-2771-7

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  • DOI: https://doi.org/10.1007/s00296-013-2771-7

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