Bisphosphonates are drugs taken by some cancer patients to treat bone-related side effects.

Bisphosphonates are drugs given to some patients whose cancer has spread to the bones. They are used to reduce pain and decrease the risk of broken bones. (See the PDQ summary on Pain for more information.) Bisphosphonates are also used to treat hypercalcemia (too much calcium in the blood). Some cancer cells secrete substances that cause calcium to be absorbed into the bloodstream from bones. (See the PDQ summary on Hypercalcemia for more information.)

Certain bisphosphonates are linked to a risk of bone loss.

Certain bisphosphonates are linked to the breakdown of bone in the mouth, usually the jaw. This is called bisphosphonate-associated osteonecrosis (BON). It occurs more often in patients taking intravenous bisphosphonates, but it sometimes develops in patients taking them by mouth. Symptoms include pain and inflamed lesions in the mouth, where areas of damaged bone may be seen. There are many patients who take bisphosphonates, but the number who develop BON is small.

BON most commonly occurs after oral surgery.

BON most commonly occurs after a dental procedure such as having a tooth pulled. The area fails to heal for weeks after the procedure. If not treated, the areas of bone loss and the lesions can become very large and infected. These patients may develop paresthesia, an abnormal feeling on the skin, such as burning or prickling, that occurs without any known physical cause. Patients with severe BON may need to be treated in a hospital or have part of the jawbone removed.

It is less common for BON to occur in patients who have not had dental procedures.

Treatment of BON usually includes treating the infection and good dental hygiene.

Treatment of BON may include the following:

• Removing the infected tissue.
• Smoothing sharp edges of exposed bone.
• Taking antibiotics to fight infection.
• Using medicated mouth rinses.

During treatment for BON, the patient should continue to brush and floss the teeth after meals to keep the mouth very clean. Avoiding tobacco use while BON is healing may be advised.

Stopping the use of the bisphosphonate is a decision to be made by the patient and doctor, based on the effect it would have on the patient's general health.

New types of bisphosphonates are being studied in clinical trials. The use of hyperbaric oxygen therapy (HBO) combined with stopping the use of bisphosphonates is under study for the treatment of BON. It is not known if tobacco use increases the risk of developing BON.

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