A systematic review 1 including 29 studies (10 case series of 10 or more individuals and 19 series or case reports of fewer than 10 patients) with a total of 368 subjects with bisphosphonate-associated osteonecrosis of the jaw was abstracted in DARE. Osteonecrosis of the jaws was associated with the use of aminobisphosphonates. Ninety-four percent of patients were treated with zoledronic acid or pamidronate or both; 85% of affected patients had multiple myeloma or metastatic breast cancer, and 4% had osteoporosis. Osteonecrosis seemed to be time- and dose-dependent because of the long half-life of aminobisphosphonates. The mandible was more commonly affected than the maxilla (2:1 ratio). 60% of the cases occured after dentoalveolar surgery (such as tooth extraction) to treat infections, and the remaining 40% were probably related to infection, denture trauma, or other physical trauma.
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