Relevance of bisphosphonate therapy in osteoporosis and cancer - no cause for alarm in dentistry (dent update 2016; 43: 235–242)

We write to challenge some of the assertions made in this recent paper.

Sadly, the attention grabbing title is rather naïve and/or misleading for general dentists and others. There is cause for concern and possible alarm in dentistry if patients, who have had multiple IV injections of bisphosphonates, usually for cancer, subsequently need to have dental extractions, or other operations involving the bone in their mouth.

While feeling great sympathy for patients who suffer from osteoporosis, the emphasis in the title of this paper and some of the content ought to be challenged, particularly in relation to intravenous bisphosphonates for patients with cancer.

Oral bisphosphonates are reputedly very beneficial in cases of osteoporosis. The risks of Medicine Related OsteoNecrosis of the Jaw (‘MRONJ’) after surgery to the jaws with oral bisphosphonates are so low that they should not be an issue for over 99% of oral surgical interventions. If oral bisphosphonates are taken for very many years and/or if they are combined with other risks, such as a long history of steroids, then the risks of MRONJ following jaw bone surgery are increased, but they are still low.¹