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Oral bisphosphonates and osteonecrosis of the jaw: are the MHRA recommendations appropriate?

The association between bisphosphonate therapy and osteonecrosis of the jaw was first reported in 2003, in patients with malignant disease who were being treated with large doses of intravenous bisphosphonates. Subsequently, possible cases of osteonecrosis of the jaw have been reported in a very small number of people taking oral bisphosphonates for osteoporosis; at the time of publication of its ‘expert panel recommendations’, the American Dental Association estimated that there were approximately 183 such cases worldwide. The word ‘possible’ is particularly apposite in the context of diagnosis of osteonecrosis of the jaw, since the disease is poorly characterized in terms of its clinical