Introduction

Beginning with the first reports in 2001 and continuing to the present time, exposed bone in the jaws and, more recently, femoral fractures caused by the toxic effects of bisphosphonates on osteoclasts have become epidemic. In less than 10 years, more than 1,100 publications have been published on bisphosphonates-induced osteonecrosis of the jaw (BIONJ). 16 organizations have produced position papers, and tens of thousands of individuals have been afflicted by this serious drug-induced adverse side effect. The predictability of BIONJ occurring in humans has long been recognized, in the historical accounts of the phossy jaw epidemic between 1850 and 1906 and in the disease of osteopetrosis. BIONJ, as well as both of these pathologies, results from the over suppression of bone turnover (renewal), such that brittle and often necrotic bone develops in areas of the skeleton subject to the highest turnover in response to compressive forces and bending forces (e.g., alveolar bone in the jaws and the mid femur). The current challenge to clinicians is not to be ambivalent concerning the cause of BIONJ, as it is due to the bisphosphonate molecule itself, with all other medical conditions and drugs playing only contributing roles as co-morbidities. Accordingly, both the dose and the frequency of administration must be moderated. In addition, dental/oral and maxillofacial surgical teams must be able to competently manage and treat these individuals to control or resolve the disease.