Bisphosphonate-related
osteonecrosis of the jaws (BON), first described in 2003, is gaining importance due to the increasing indication spectrum of
bisphosphonate therapy [S. Takeyama, M. Ito, H. Shinoda, A novel
bisphosphonate,
TRK-530, for
periodontitis, Bone 38 (2006) 31-31; M. Tagil, A. W-Dahl, J. Astrand, D. Little, S. Toksvig-Larsen, Decreasing the catabolic response by a single
bisphosphonate infusion shortens the healing time in hemicallotasis operations, Bone 38 (2006) 84-85; E. Rodriguez, M.C. Duran, L.M. Rodriguez, R. Ros, M.R. Aleman, M. Rodriguez-Gaspar, A.M. Lopez, E. Garcia-Valdecasas, F. Santolaria, Intravenous (IV)
bisphosphonates for osteopenic cancer survivor women: an alternative treatment, Bone 38 (2006) 72-73; D.G. Little, K. Ward, P. Kiely, M.C. Bellemore, J. Briody, C.T. Cowell,
Bisphosphonate rescue in
distraction osteogenesis: a case series, Bone 38 (2006) 80-80; R. Marx,
Pamidronate (
Aredia) and
zoledronate (
Zometa) induced avascular
necrosis of the jaws: a growing epidemic, J. Oral Maxillofac. Surg. 61 (2003) 1115-1118]. BON patients suffering from varying bony defects and symptoms are extremely restricted in their quality of life. Due to a limited knowledge of the aetiology of BON efficient evidence-based treatment strategies are lacking. Until now 23 patients with
bisphosphonate-related
osteonecrosis have been admitted to the Department of Cranio-
Maxillofacial Surgery of the University of Zurich. A complete history has been recorded. All patients underwent clinical and radiographic examination. CT scans and MRI have been performed in selected cases. All patients had in common that, before signs of BON were observed, a local traumatic incidence had occurred. All patients showed signs of
infection which could be remarkably reduced by antibacterial treatment. Furthermore, the period of
bisphosphonate treatment was found to be one of the significant factors causing
bisphosphonate-related
osteonecrosis of the jaws. The aetiology of BON appears to depend on multiple factors: period and type of
bisphosphonate therapy and
trauma paving the way for an invasion of pathogens. Because evidence based
therapy protocols for complete remodelling of bone defect are still missing, prevention in
bisphosphonate-treated patients seems to be of utmost importance. A close interdisciplinary collaboration is required.