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Bisphosphonates and osteonecrosis: Potential treatment or serious complication
Orthopedic Clinics of North America, 04/29/09

Goytia RN et al. - This article reviews the use of bisphosphonates to treat osteonecrosis of the femoral head. Bisphosphonates do have side effects, including the paradoxical association with osteonecrosis of the jaw, which is also discussed in detail in this article.

Oral use of bisphosphonates for osteonecrosis of the hip has shown some early promising results, although the exact mechanism has not been elucidated
Theoretically, bisphosphonates target the collapse that results from resorption of the necrotic bone
Long-term use of these drugs needs to be weighed against the possible systemic side effects
Although theoretically their role shows potential, they should be used cautiously and not indefinitely
This family of drugs although is targeted to treat osteonecrosis of the femoral head, there is an association with its production of osteonecrosis in the jaw
Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a relatively new clinical phenomenon associated with exposure to all bisphosphonates, although it occurs far more commonly with the potent IV amino-substituted drugs
Currently, the benefits of bisphosphonates outweigh the risks for most pts who have cancer

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