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.
References
Marx RE, Sawatari Y, Fortin M, Broumand V . Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg 2005; 63: 1567–1575.
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Scully, C. No evidence. Br Dent J 200, 474 (2006). https://doi.org/10.1038/sj.bdj.4813572
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DOI: https://doi.org/10.1038/sj.bdj.4813572