Sir, Dr Harrison (BDJ 2006; 200: 242–243) asks about management of bisphosphonate-related osteochemonecrosis. Three bisphosphonates, pamidronate (Aredia; Novartis), zoledronate (Zometa; Novartis ), and alendronate (Fosamax; Merck) have been linked to this painful problem that can affect the jaw bones. There certainly are no evidence-based management protocols.

Probably the most comprehensive work on the subject is by Robert Marx, in a paper that concludes 'Complete prevention of this complication in not currently possible. However, pre-therapy dental care reduces this incidence, and non-surgical dental procedures can prevent new cases. For those who present with painful exposed bone, effective control to a pain free state without resolution of the exposed bone is 90.1% effective using a regimen of antibiotics along with 0.12% chlorohexidine antiseptic mouth'.1 As far as I am aware, surprisingly there is no evidence that cessation of bisphosphonate therapy helps once the condition has arisen.