Alternative indications for bisphosphonate therapy.

Bisphosphonates are currently used in the treatment of osteoporosis (postmenopausal and steroid-induced), hypercalcemia of malignancy, Paget's disease of bone, multiple myeloma, and skeletally related events associated with metastatic bone disease in breast, prostate, lung, and other cancers. There are, however, numerous other conditions where a decrease in bone remodeling by bisphosphonates might aid in disease management. The focus of this review will be to discuss a select group of conditions for which bisphosphonate therapy may be efficacious. In this review we present several cases where bisphosphonates have been used as a primary or adjunctive treatment for giant cell lesions of the jaws. Use of bisphosphonate therapy for giant cell tumors of the appendicular skeleton, pediatric osteogenesis imperfecta, fibrous dysplasia, Gaucher's disease, and osteomyelitis will be discussed. Finally, we will review previous in vivo studies on the use of bisphosphonates to augment integration and to treat osteolysis surrounding failing orthopedic implants.

Bisphosphonate-associated osteonecrosis of the jaw: conclusions based on an analysis of case series.

ONJ appears to be associated with BPs; however, the pathophysiology, incidence, and co-morbidities require further investigation. The major risk factors identified to date appear to be cancer (or chemotherapy for cancer) and dental procedures or oral trauma. A clear definition of ONJ is critical to understanding this disease entity. Although recommendations regarding the prevention and management of ONJ exist, clinical studies are needed to establish more definitive guidelines for the management of ONJ. The use of intensive hyperbaric oxygen therapy may be beneficial to patients with ONJ.