Osteonecrosis of the jaw and bisphosphonates--putting the risk in perspective.

Osteonecrosis of the jaw is a poorly understood condition that has recently been associated with the use of potent bisphosphonate treatment. The prevalence appears to be approximately 1-10% in patients with malignancy treated with very high doses of intravenous bisphosphonates. In Paget's disease and osteoporosis, where the doses of bisphosphonate used are an order of magnitude lower than the oncology dose, the prevalence appears to be much lower--probably less than 1 in 60,000. The aim of this article is to put the risks of osteonecrosis of the jaw into context with the benefits of bisphosphonate treatment in these clinical scenarios.