Medication-Induced Osteonecrosis: Risks and Prevention

Discover medications related to osteonecrosis and how to prevent this condition.

Medication-induced osteonecrosis of the jaw is a serious complication, and various medications, including bisphosphonates, can increase this risk. In this article, we explore the medications and drug classes related to osteonecrosis, explain the mechanisms involved, and discuss strategies for preventing and treating this condition.


Medications Associated with Osteonecrosis:


Patients who use bisphosphonates, such as alendronate and zoledronate, have an increased risk of developing osteonecrosis of the jaw. In addition to these medications, other substances have also been associated with cases of osteonecrosis, including:


  1. Antiangiogenics:

– Bevacizumab

– Sunitinib

– Sorafenib


  1. Immunosuppressants:

– Methotrexate

– Cyclosporine

– Tacrolimus


  1. Disease-Modifying Antirheumatic Therapy:

– Adalimumab

– Infliximab


  1. Targeted Therapy Inhibitors:

– Denosumab

– Everolimus


  1. Other Medications:

– Corticosteroids (at high doses and/or for prolonged periods)


Mechanisms of Osteonecrosis Induction:


Medication-induced osteonecrosis of the jaw generally occurs due to a decreased blood supply to the maxillary bones. Bisphosphonates, for example, can inhibit the activity of osteoclasts, cells responsible for bone resorption, leading to excessive suppression of this activity. This can impair the bone’s ability to repair itself, making it more susceptible to injuries and infections.


Prevention and Treatment:


Prevention is crucial when it comes to medication-induced osteonecrosis. Patients who are using medications associated with this risk should undergo a comprehensive dental evaluation before starting treatment. During treatment, maintaining good oral hygiene and reporting any bone-related symptoms or pain to a healthcare professional is essential.


In cases of suspected or diagnosed osteonecrosis, treatment may involve temporary or permanent discontinuation of the triggering medication, along with measures to promote bone healing and control infections. Specialized medical follow-up is crucial to guide treatment and ensure the patient’s well-being.




Medication-induced osteonecrosis of the jaw is a serious condition that requires special attention and care, especially in patients using medications associated with this risk. Prevention, through proper assessment and rigorous dental care, plays a fundamental role in reducing this risk. When necessary, treatment should be conducted by specialized professionals to ensure the best outcomes and patient safety. If you are using medications that increase the risk of osteonecrosis, consult with your doctor and dentist about the best prevention and management strategies.

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