Incidence of Jaw Necrosis Is Markedly Higher

Abstract

The authors mention “osteonecrosis of the jaw” among the side effects of bisphosphonates, which is said to develop in up to 1% of patients. This figure is not supported by any literature reference and contradicts the available epidemiological data. The incidence of jaw necrosis in cancer patients who are receiving intravenous bisphosphonate therapy is notably higher and reaches up to double-figure percentages (1). In osteoporosis patients taking oral bisphosphonates, the prevalence is 0.1%, and 0.2% after 4 years of treatment (2). The correlation described in the article, of “mechanical injury through dental procedures,” is also an inadmissible conclusion from the fact that some two thirds of patients with bisphosphonate induced osteonecrosis of the jaw had had teeth extracted according to their history; a fact that was established in retrospective data collections. Although there are indications that changing (peri-)operative procedures for necessary extractions may reduce the risk of jaw necrosis in patients taking bisphosphonates, but about one third of jaw necroses develop spontaneously, without external factors (3). In my opinion it would have been important to provide information about prevention in the article; this entails in particular the early detection of any lesions. Examination and treatment by an oral and maxillofacial surgeon or competent dentist before and during therapy with bisphosphonates would make sense. The interdisciplinary S3 guideline for the diagnostic evaluation, therapy, and aftercare of breast cancer has pointed out this important aspect since 2008 (http://www.awmf.org/fileadmin/user_upload/Leitlinien/032_D_Krebsgesellschaft/Gynaekologie/032–045e_S3_Diagnosis_Treatment_and_Follow_up_Care_of_Breast_Cancer_04–2008_12–2010.pdf).