Definitions of Bisphosphonate-associated Bone Necrosis

Bisphosphonate-associated Bone Necrosis

In a Bisphosphonate-associated bone necrosis is a necrosis of the bone that occur as a result of treatment with bisphosphonates. In the majority of cases, the bone necrosis occurs after therapy at the dentist or orthodontist, after bisphosphonates have been used. This is why bisphosphonate-associated bone necrosis of the jaw occurs particularly frequently. In addition, spontaneous bisphosphonate-associated bone necrosis are possible.

What is bisphosphonate-associated bone necrosis?

Bisphosphonate-associated bone necrosis is caused by the medicinal active ingredients of bisphosphonates. Bisphosphonates are substances that inhibit the breakdown of bones. For this reason, they are used, for example, as medicines for osteoporosis or bone metastases.

They have a strong affinity on the surface of the bones and affect the osteoclasts. As a result, bone resorption is reduced. If the breakdown of the bone substance is accelerated, for example by an osteoporosis disease or metastases on the bones, bisphophonates inhibit this breakdown and thus counteract the disease.

Therapy with bisphosphonates also briefly increases the density of the bone substance. The half-life of bisphosphonates inside the bone is extraordinarily long and sometimes more than ten years. This requires strict standards in the medical use of bisphosphonates. Bisphosphonates are currently approved mainly for the treatment of metastases to the bones and osteoporosis after menopause.


The exact mechanisms underlying bisphosphonate-associated bone necrosis have not yet been clarified. There is still a need for research into the pathogenesis of people receiving bisphosphonates as part of systemic treatment. Some doctors suspect a connection to the inhibition of osteoclasts and osteoblasts. This can lead to a depression of the osteoblasts, so that the ability of the bone to regenerate decreases.

In the meantime, bisphosphonate-associated bone necrosis represents a considerable problem for medicine. Especially in people with cancer, after intravenous administration of bisphosphonates, bisphosphonate-associated bone necrosis develop in almost 20 percent of cases. In benign diseases such as osteoporosis, the risk of bisphosphonate-associated bone necrosis is only 0.1 percent.

Symptoms, ailments & signs

In the context of bisphosphonate-associated bone necrosis, necrotic areas develop on the bones of the diseased patient. The disease is sometimes severe, whereby the individual course of bisphosphonate-associated bone necrosis differs greatly in individual cases and also depends on the underlying diseases.

People who suffer from cancer and are taking immunosuppressive drugs are at a particular risk for bisphosphonate-associated bone necrosis. Basically, bisphosphonate-associated bone necrosis mainly occurs in connection with amino-bisphosphonates, which the doctor injects intravenously.

Diagnosis & course

The diagnosis of bisphosphonate-associated bone necrosis is made by a specialist doctor. The anamnesis focuses on the discussion of the patient’s underlying diseases and treatment with bisphosphonates in the past. When diagnosing it should be noted that the bisphosphonate associated

In some cases, bone necrosis does not develop until some time after the administration of bisphosphonates. This fact is due to the long half-life of bisphosphonates in the substance of the bone. For this reason, a thorough medical history at the beginning of the diagnosis of bisphosphonate-associated bone necrosis is essential. The clinical examination of the sick person is based on various procedures.

For example, the doctor measures the bone density and uses imaging methods of the bones. For example, X-ray or MRI examinations are possible. In addition, the attending physician may puncture the bone and order a laboratory analysis of the tissue samples obtained. In general, blood analyzes also play an important role in the diagnosis of bisphosphonate-associated bone necrosis.


Bone necrosis associated with bisphosphonate is a very serious disease. The further course and the complications depend heavily on the underlying disease. In most cases, diagnosis can be made relatively quickly, so treatment can be started early. A blood analysis will also be carried out.

Treatment is primarily aimed at stopping medication. This can stop and limit the symptoms and prevent the disease from spreading any further. If the person concerned is expecting another surgical procedure, antibiotics are used instead. The operation is carried out with great care so that there is no trauma to the affected area.

If the disease occurs in a cancer patient, the treatment must be discussed with a doctor, since the use of bisphosphate inhibits the breakdown of the bones, but contributes to the disease. A direct and causal treatment of this disease is unfortunately not possible. Life expectancy is greatly reduced. As a rule, this is based on the expectation of the tumor. During the treatment, there are no further complications for the patient that arise directly from the treatment.

When should you go to the doctor?

In the event of this complaint, a doctor must be consulted immediately. As a rule, there is no self-healing, so that an improvement in the symptoms is only possible by discontinuing or changing the respective medication. However, this should only ever be done following a doctor’s instruction. As a rule, the doctor should be consulted if bone necrosis occurs.

In particular, if the pain is severe or if there are significant restrictions in everyday life and movement, the person concerned must consult a doctor. This also applies to patients who have cancer and for this reason are taking medication that can lead to bone necrosis. In most cases, the diagnosis and treatment of this condition will be carried out by a specialist doctor. X-rays or MRIs are necessary for this.

Further treatment depends heavily on the underlying disease and is also carried out by a specialist. It cannot be universally predicted whether the outcome will be completely positive.

Treatment & Therapy

The options for treating bisphosphonate-associated bone necrosis have so far been relatively limited. For the time being, the most important approach in the therapy of bisphosphonate-associated bone necrosis is to discontinue the administration of bisphosphonates. If surgery is required in the patients treated with bisphosphonate, they are given antibiotics.

In addition, the doctors try to cause as little trauma as possible in the operated areas. Basically, it is recommended that therapeutic measures and follow-up controls for bisphosphonate-associated bone necrosis be carried out in suitable specialist medical centers. If bisphosphonate-associated bone necrosis occurs in cancer patients, further therapy for bone metastases must be weighed against the disease.

The use of bisphosphonates inhibits the breakdown of bone substance, but at the same time leads to the development of bisphosphonate-associated bone necrosis. Since the exact causes of the development of bisphosphonate-associated bone necrosis are not yet precisely known, adequate treatment options are also lacking. However, medical research is concerned with the development of active substances and methods against bisphosphonate-associated bone necrosis.

Outlook & forecast

The chances of recovery from bisphosphonate-associated bone necrosis are very slim. Despite medical advances, researchers and scientists have so far failed to find adequate treatment to cure the disease. Bisphosphonate-associated bone necrosis has a progressive disease course that cannot be stopped.

Without medical care there is continuous bone loss in the patient. There are other complaints that make the patient’s everyday life very difficult. Medical care is an attempt to slow the progression of the disease. In addition, side effects are treated. This increases the well-being of the person concerned significantly.

A very unfavorable course can be observed in patients with cancer. The patient’s organism is very weakened by the treatment and the cancer therapy. This minimizes the prospect of a further alleviation of the symptoms of bisphosphonate-associated bone necrosis.

If the underlying disease is mild, the patient is in good health and the diagnosis is early and the treatment for bone necrosis can be started as soon as possible, there are the best chances for an improvement in the state of health. The organism can be optimally supplied with various medicines in order to contain the progress of the disease as much as possible. Although there is no cure, it does manage to stop the deterioration in some patients.


Medical research has identified various risk factors to prevent bisphosphonate-associated bone necrosis. Necrosis on the jawbone occurs in cancer patients especially with high doses of the active ingredients. In this case, lesions develop exclusively with drugs with nitrogen. The risk of bisphosphonate-associated bone necrosis is reduced if people take the bisphosphonates in the form of tablets instead of injections.

In contrast, intravenous administration increases the likelihood of bisphosphonate-associated bone necrosis. Carrying out highly invasive dental therapy measures such as inserting implants, pulling teeth or treating the tooth root also increase the risk of the disease. If dental treatment is required, it is advisable to conclude it before therapy with intravenously administered bisphosphonates.


Follow-up care is usually not possible for this disease. Those affected are dependent on therapy, but a complete cure of the disease is not possible. Since the symptoms can be limited with the help of antibiotics, the patient should ensure that the medication is taken regularly and also consider possible interactions with other medications.

If the disease is caused by a tumor, regular examinations should be carried out in order to identify and treat other tumors quickly and at an early stage. The life expectancy of the person affected is very often significantly limited with this disease. As the disease can often lead to psychological complaints, psychological counseling is very useful during treatment.

Contact with other people affected by the disease can also prove useful and lead to an exchange of information. Often the relatives of the patient also need psychological treatment. If the disease is being treated by surgery, care should be taken to ensure that the patient is able to recover sufficiently after the procedure. The wounds must heal completely, whereby the operation itself must not cause any other damage to the body in order to avoid further trauma.

You can do that yourself

Bone necrosis associated with bisphosphonate is a disease that requires treatment. In the context of self-help measures, no adequate relief of the symptoms can be achieved. Therefore, the person affected should discuss the symptoms and changes in cooperation with a doctor they trust.

Since medication is first given to alleviate symptoms, side effects and changes should be taken into account. The medication is not to be changed or discontinued on your own responsibility. The consumption of alcohol is to be avoided, as the body is overwhelmed in interaction with the active ingredients of the drugs and complications arise. These worsen the quality of life considerably and cause delays in the healing process.

If a surgical procedure is necessary, the risk factors should be reduced in advance. Stress is to be avoided and well-being is to be promoted. A balanced and healthy diet can stabilize the body’s immune system. This is of immense importance in the healing process and especially after an operation. Do not consume harmful substances such as nicotine, drugs or caffeine. They delay the recovery of those affected and also trigger complications.

If the bone necrosis shows up in the area of ​​the jaw, adequate dental care must be carried out despite all the adversities. The optimal care of the mouth should be discussed with a dentist so that no secondary diseases are triggered.

Bisphosphonate-associated Bone Necrosis