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Letter to the editor

Editor, – We wish to draw readers attention to a potential drug-related cause of painful bone exposure in the maxilla complicating the healing of dental extractions. We have recently had four such cases in our unit all of whom were unresponsive to local medical and surgical treatments. All these patients were taking bisphosphonates; three were receiving pamidronate and one was receiving alendronate. This group of drugs act primarily through osteoclastic inhibition of bone resorption and are commonly prescribed in Australia to treat a variety of conditions including Paget's disease, hypercalcaemia of malignancy and osteoporosis.

On review of the literature we located a recent letter to the Journal of Oral and Maxillofacial Surgery which highlighted a growing epidemic of bisphosphonate-induced a vascular necrosis of the jaws.1 The particular bisphosphonates implicated in the series of 36 patients are the potent nitrogen-containing bisphosphonates that are not metabolised, namely pamidronate and zoledronate. Interestingly, alendronate is also a potent nitrogen-containing bisphosphonate that is not metabolised. Consequently, we support the proposal of a link between a vascular necrosis of the jaws and certain bisphosphonates currently prescribed in Australia. We draw this to the attention of practitioners prescribing these medications as a significant adverse effect.

G. D. Carter
Senior Registrar

A. N. Goss
Professor and Director
Oral and Maxillofacial Surgery Unit
Royal Adelaide Hospital, Adelaide Dental Hospital
Professor of Oral and Maxillofacial Surgery
School of Dentistry
University of Adelaide, Adelaide


  1. Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced a vascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 2003;61:1115-7.