Background A single infusion of intravenous zoledronic acid decreases bone turnover and improves bone density at 12 months in postmenopausal women with osteoporosis. We assessed the effects of annual infusions of zoledronic acid on fracture risk during a 3-year period. Methods In this double-blind, placebo-controlled trial, 3889 patients (mean age, 73 years) were randomly assigned to receive a single 15-minute infusion of zoledronic acid (5 mg) and 3876 were assigned to receive placebo at baseline, at 12 months, and at 24 months; the patients were followed until 36 months. Primary end points were new vertebral fracture (in patients not taking concomitant osteoporosis medications) and hip fracture (in all patients). Secondary end points included bone mineral density, bone turnover markers, and safety outcomes. Results Treatment with zoledronic acid reduced the risk of morphometric vertebral fracture by 70% during a 3-year period, as compared with placebo (3.3% in the zoledronic-acid group vs. 10.9% in the ...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa067312

Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis

http://media.onj.nu/2013/08/AAOMS-Position-paper-ONJ_2014.pdf

American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update.

American Association of Oral and Maxillofacial Surgeons Position Paper on Bisphosphonate-Related Osteonecrosis of the Jaws—2009 Update

http://www.endoexperience.com/filecabinet/Diagnosis%20and%20Treatment%20Planning/Systemic%20Considerations/Bisphisphonates/J%20Oral%20Maxillofac%20Surg_Marx.pdf

Bisphosphonate-Induced Exposed Bone (Osteonecrosis/Osteopetrosis) of the Jaws: Risk Factors, Recognition, Prevention, and Treatment

ONJ has been increasingly suspected to be a potential complication of bisphosphonate therapy in recent years. Thus, the ASBMR leadership appointed a multidisciplinary task force to address key questions related to case definition, epidemiology, risk factors, diagnostic imaging, clinical management, and future areas for research related to the disorder. This report summarizes the findings and recommendations of the task force. Introduction: The increasing recognition that use of bisphosphonates may be associated with osteonecrosis of the jaw (ONJ) led the leadership of the American Society for Bone and Mineral Research (ASBMR) to appoint a task force to address a number of key questions related to this disorder. Materials and Methods: A multidisciplinary expert group reviewed all pertinent published data on bisphos- phonate-associated ONJ. Food and Drug Administration drug adverse event reports were also reviewed. Results and Conclusions: A case definition was developed so that subsequent studies could report on the same condition. The task force defined ONJ as the presence of exposed bone in the maxillofacial region that did not heal within 8 wk after identification by a health care provider. Based on review of both published and unpublished data, the risk of ONJ associated with oral bisphosphonate therapy for osteoporosis seems to be low, estimated between 1 in 10,000 and <1 in 100,000 patient-treatment years. However, the task force recognized that information on incidence of ONJ is rapidly evolving and that the true incidence may be higher. The risk of ONJ in patients with cancer treated with high doses of intravenous bisphosphonates is clearly higher, in the range of 1-10 per 100 patients (depending on duration of therapy). In the future, improved diagnostic imaging modalities, such as optical coherence tomography or MRI combined with contrast agents and the manipulation of image planes, may identify patients at preclinical or early stages of the disease. Management is largely supportive. A research agenda aimed at filling the considerable gaps in knowledge regarding this disorder was also outlined. J Bone Miner Res 2007;22:1479-1491. Published online on July 19, 2007; doi: 10.1359/JBMR.0707ONJ

http://www.endoexperience.com/documents/BRONJReportofaTaskForceoftheAmerSocofBoneMineralResearch.pdf

Bisphosphonate-associated osteonecrosis of the jaw: Report of a Task Force of the American Society for Bone and Mineral Research

http://www.hyperbaricinformation.com/HBO-Articles/HBO-Radiation/Bisphosphonate-Osteonecrosis/J-Oral-Maxillofac-Surg-2004-62-527-Ruggiero-Osteonecrosis-ja.pdf

Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases

Treating bisphosphonate osteonecrosis of the jaws: is there a role for resection and vascularized reconstruction?

Metastasis to the percutaneous endoscopic gastrostomy site in the patient with head and neck cancer: a case report and review of the literature.

Strength analysis of titanium and resorbable internal fixation in a mandibulotomy model.

The management of patients with established bisphosphonate-related osteonecrosis of the jaws (BRONJ) remains unclear. The patient discussed here presented with spontaneous BRONJ of the palate after taking an oral bisphosphonate for osteoporosis. Conservative management resulted in progression of the osteonecrosis. Surgical debridement and immediate reconstruction with free tissue transfer was undertaken and resulted in complete resolution of her condition. The case is presented here.

Stephen L. Engroff

Papers

Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases

Treating bisphosphonate osteonecrosis of the jaws: is there a role for resection and vascularized reconstruction?

Metastasis to the percutaneous endoscopic gastrostomy site in the patient with head and neck cancer: a case report and review of the literature.

Strength analysis of titanium and resorbable internal fixation in a mandibulotomy model.

Bisphosphonate related osteonecrosis of the palate: report of a case managed with free tissue transfer