Osteonecrosis of the Jaw

Osteonecrosis of the Jaw: Looking at one of the more painful and life altering side effects of many osteoporosis medications.


Photograph of ONj of the left maxilla of a pat...

Photograph of Osteonecrosis of the Jaw, left maxilla. 4 October 2006 by Jacques Imbeau, Dr. Imbeau  (Photo credit: Wikipedia)

The word “Osteonecrosis” in Latin means bone death. This condition is caused by diminishing blood supply to the particular area of bone. Though most commonly diagnosed in the hip, shoulder, knee, elbow, wrist and ankle, as a side effect of bisphosphonate drugs this condition is seen in the jaw. This condition is referred to as “osteonecrosis of the jaw.” Bisphosphonate drugs are the most common drug type to be prescribed to treat low bone mass density and osteoporosis. As osteonecrosis begins onset, the bone or a part of the bone does not get blood and osteoblasts (bone cells) cease functioning. Over time the bone can collapse, and if not treated, the joints will deteriorate and become severely arthritic. Osteonecrosis can be caused by disease, severe trauma to bones and joints, an effect of several different disease states, and manifesting in the jaw as a side effect of bisphosphonate drug use.

Symptoms of Osteonecrosis

There are no symptoms in the early stages, however as bone damage escalates, individuals may experience increasing joint pain over time with pain felt even when at rest, and a limiting in range of motion. A manifestation in this condition in the jaw makes chewing food and speaking extremely painful. X-rays, DXA scans and MRI devices are all used to diagnose this condition. A health care provider will do a complete physical exam to find out if an individual has any diseases or condition that affects bone, especially for individuals who are taking bisphosphonate drugs for bone density. If symptoms are noticed, questions will be asked about medical history, if you are in enough pain that you are kept up at night, if your mobility is limited, as well as questions about what chemicals/foods are ingested like alcohol and supplements that could impact bone health.

Treatment for Osteonecrosis and Osteonecrosis of the Jaw

If a health care provider knows the reason for osteonecrosis (potentially osteoporosis medication), part of the treatment will be aimed at the underlying condition. If the condition is diagnosed early, alterations in diet, exercise and medications can stop and reverse the condition. If not, surgical options including bone grafts and total joint replacements can be the only options. This option can be extremely painful for osteonecrosis of the jaw. The general dental opinion on this bisphosphonate drugs are negative for this reason. See: TodaysDentist.Org



Chang C, Greenspan A, Gershwin ME. (2008) Osteonecrosis. In: Firestein GS, Budd RC, Harris ED Jr, et al, eds. Kelley’s Textbook of Rheumatology. 8th ed. Philadelphia, Pa: Saunders Elsevier;:ch 94.

Shah A, Busconi B. (2009). Hip, pelvis, and thigh: Hip and pelvis. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; chap 21, section A.


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