Guidelines for treatment of bisphosphonate- induced avascular osteochemonecrosis of the jaws: A comparative literature review and 2 case reports

We can distinguish three generations of bisphosphonate. The first is formed of the non-aminobisphosphonate (Etidronate, Clodronate), the second correspond to the aminobisphosphonates (Pamidronate, Alendronate) that are 100 to 500 times more powerful, and the third generation (Ibandronate, Risedronate and Zoledronate) that is 10 to 20 times more powerful than the previous generations in terms of reducing skeletal-related events (SRE; defined as pathological fracture, surgery to bone and hypercalcemia).3 The addition of nitrogen increases the potency of bisphosphonates in inhibiting bone resorption than non-aminobisphosphonates.4 In recent years, many cases of osteochemonecrosis have been reported involving both oral and intravenous therapy regimens.5 Marx in 20036 described the first case of osteochemonecrosis of the jaw associated with bisphosphonate therapy; since then the number of cases reported is increasing and has become a "growing epidemic. Guidelines for treatment of bisphosphonateinduced avascular osteochemonecrosis of the jaws: A comparative literature review and 2 case reports