Medications (bisphosphonates) associated with Osteonecrosis of the Jaw (BONJ, MRONJ)

Dentists are now routinely engaging with physicians who are contemplating prescribing bisphosphonate medications for their patients with osteoporosis. It is now the standard of care to order a full dental exam and full mouth x-rays prior to prescribing bisphosphonates due to potential oral side effects from these medications. Bisphosphonates alter the regeneration of bone which enhances bone density and prevents bone fractures. They are also prescribed in cancer patients to help prevent metastasis to the bone. 

The primary oral side effect about which physicians and dentists are concerned is the lack of healing following dental surgeries that expose bone. This is a rare but significant event. The best prevention is to determine prior to prescribing bisphosphonates if there is any potential for oral or periodontal surgery that will expose bone in the near future. If so, that surgery should be performed prior to the patient taking bisphosphonates. The popular acronyms for this condition in the literature are BONJ (Bisphosphonate-related Osteonecrosis of the Jaw) and MRONJ (Medication-related Osteonecrosis of the Jaw).

Common brand name bisphosphonate medications include: (generic name in parentheses)

Actonel (Risedronate)

Aredia (Pamidronate)

Boniva (Ibandronate)

Didronel (Etidronate)

Fosamax (Alendronate)

For a more complete description and discussion of the condition our Dental CE course on BONJ (MRONJ) is available online for immediate download at Dental Didactics CE