Patient Resource on Bisphosphonates and ONJ


Dentists can now access a patient resource on bisphosphonates as they relate to oral health. This class of medications has been examined extensively, to assess its possible relationship with osteonecrosis of the jaw (ONJ).

The brochure, Osteoporosis bisphosphonate medications, dental health and osteonecrosis of the jaw (ONJ). What you need to know, addresses some of the misconceptions that may persist regarding the strength of association between bisphosphonates and ONJ.

According to the brochure, ONJ has been noted in some cancer patients receiving high doses of intravenous bisphosphonates on a monthly basis. However, in patients with osteoporosis, bisphosphonates are used in very low doses and there is currently no definitive evidence showing that low doses of bisphosphonates increase the risk of ONJ.

The organizations who joined forces to produce this brochure are the Canadian Task Force on ONJ, Osteoporosis Canada, the Ontario Dental Association (ODA), the Canadian Association of Oral and Maxillofacial Surgeons, the Society of Obstetrics and Gynecology of Canada and the Canadian Society of Endocrinology and Metabolism.

Dr. Archie Morrison, associate professor in the department of oral and maxillofacial sciences at Dalhousie University, is a member of the Canadian Task Force on ONJ. He notes that the task force will meet again in September to establish research priorities to better understand the various causes of ONJ, along with identifying effective forms of treatment.

In the patient brochure, the ODA recommends:

For cancer patients:

  • If possible, before starting high-dose intravenous bisphosphonate therapy, a detailed dental examination should be completed with radiographs of the jaw bones. Any necessary dental surgery should ideally also be completed before starting such therapy.

For osteoporosis patients:

  • If oral surgery is needed, this surgery should ideally be completed before starting low dose oral or intravenous yearly bisphosphonate therapy, if possible.

  • Some individuals on bisphosphonate therapy may be advised to stop treatment 3 months before dental surgery and to restart therapy after the surgical site has completely healed.

  • Routine dental work such as dental cleaning, fillings or root canals do not require temporary stoppages of bisphosphonate treatment.

This patient brochure is available from the Osteoporosis Canada website at:

Related resources

Khan AA, Sándor GK, Dore E, Morrison AD, Alsahli M, Amin F, et al. Canadian Consensus Practice Guidelines for Bisphosphonate Associated Osteonecrosis of the Jaw. J Rheumatology. 2008;35(7):1391-7.

Lam DK, Sándor GK, Holmes HI, Evans AW, Clokie CM. A review of bisphosphonate-associated osteonecrosis of the jaws and its management.J Can Dent Assoc. 2007;73(5):417-22.