The 21st Century disease – BONJ

Much has been discussed about its history, but what exactly is the disease?
It has been described by several terms and when I do literature search, I have to look under more than one name: bisphosphonates associated/related/induced osteonecrosis of the jaw, or osteochemonecrosis…… and the list goes on.

B – Bisphosphonates: drug used in treating osteoporosis, bone cancer and other bone diseases, such as osteogenesis imperfecta (brittle bone disease) and Paget’s disease. It was first introduced in the 1990s and its effects on the jaw were not known then. In the early 2000s, a few cases of jaw bone death were reported and all these patients were on bisphosphonates.

Associated/related/induced – these ambiguous terms reflect the fact that we don’t yet know exactly how bisphosphonates cause jaw bone death.

ONJ – OsteoNecrosis of the Jaw: bone (osteo) death (necrosis) at the upper and/or lower jaw.

If you know people who are on bisphosphonates, don’t go crazy warning them against BONJ. They should already have been informed by their prescribing physicians. It is not advisable for patients to stop medication on their own without consulting their physicians. Fortunately, not all patients taking the drug develop jaw diseases: BONJ occurs in 0.1-10% of patients only (it however can be severe).

The clinical features, diagnosis and management of BONJ will be discussed in later blog entries.

  • McLeod, Niall M.H., Peter A. Brennan, and Salvatore L. Ruggiero. 2012. “Bisphosphonate Osteonecrosis of the Jaw: A Historical and Contemporary Review.” The Surgeon 10 (1) (February): 36–42.
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