Departmental Papers (Dental)

Document Type

Technical Report

Date of this Version


Publication Source

Case Reports in Clinical Medicine





Start Page


Last Page





Osteonecrosis of the jaw (ONJ) is an adverse effect of nitrogen-containing bisphosphonates. Advancing age, intravenous administration of zoledronic acid (ZOL), history of dento-alveolar surgery, and concomitant systemic diseases such as diabetes are known as risk factors for developing ONJ. However, despite numerous studies, the exact pathophysiology remains unclear and management strategies are largely anecdotal. Once-yearly intravenously administered 5 mg ZOL was approved by the US Food and Drug Administration in 2007 for the treatment of osteoporosis and its efficacy with 3 year-regimen had been recently been proven in preventing new clinical fracture. Although occurrences of ONJ have been reported to be rare with this drug administration, available data is very limited and long-term outcomes are lacking. We present a case of ONJ identified in an osteopenic patient with an intermittent but long standing sore mouth related to exposed mandibular bone. Once-yearly infusion of zoledronic acid used in the treatment of osteopenia may contribute to the spontaneous development of ONJ, especially in those presenting with multiple comorbidity factors. This report suggests the importance of health care professionals keeping abreast of new developments in this area and providing appropriate information to their patients.

Copyright/Permission Statement

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.


This item was published when Dr. Tanaka was affiliated with the University of Detroit Mercy School of Dentistry, but she is now a faculty member at the University of Pennsylvania.


osteopenia, osteoporosis, bisphosphonates, osteonecrosis, letrozole, once-yearly zoledronic acid, ONJ, ARONJ, BRONJ



Date Posted: 11 May 2018

This document has been peer reviewed.