Osteonecrosis

Abstract Bisphosphonates (BPs) are a widely used class of drugs with known ef fi cacy in the prevention and treatment of postmenopausal and steroid-induced osteoporosis; Paget’s disease of bone; hypercalcemia of malignancy; osteolytic lesions of multiple myeloma; and bone metastases associated with breast, prostate, lung, and other soft tissue tumors. When compared to many other therapies, especially in the cancer setting, the severity of adverse events related to BPs is generally mild, and side effects are infrequent. Thus, the bene fi ts of treatment with BPs almost always outweigh the risks. However, several side effects such as upper aerodigestive tract issues, effects concerning renal function, and acute-phase reactions have been described. In 2003, a fourth adverse effect, bisphosphonate-associated osteonecrosis of the jaw, was described for the fi rst time and has been diagnosed with increasing frequency. However several other heretofore unrecognized side effects of BPs were recently reported such as ocular side effects, atrial fi brillation, esophageal cancer, cutaneous reactions, atypical fractures of the femoral diaphysis, hypocalcemia, and hepatitis. The present work provides a literature review and update on bisphosphonate treatment to explore the risk of adverse drug reactions in patients treated with BPs.