title: Fibrous Dysplasia and Medication-Related Osteonecrosis of the Jaw.
abstract: OBJECTIVE
  Osteonecrosis of the jaw (ONJ) is an established side effect of intravenous bisphosphonates and other antiresorptive medications. Although bisphosphonates are frequently prescribed for patients with the skeletal disorder fibrous dysplasia (FD), there are no reports of ONJ in this population. This has led some to conclude that patients with FD are at low risk for the development of bisphosphonate-related ONJ.
  
  
  METHODS
  Patients were evaluated as part of a longstanding FD natural history study at the National Institutes of Health.
  
  
  RESULTS
  Of 76 patients with FD who were treated with bisphosphonates, 4 developed ONJ (5.4%). Three patients developed ONJ in areas of FD-affected bone and 1 in an area of normal bone. All 4 patients had features known to be associated with ONJ in the general population, including long-term high-dose intravenous bisphosphonate treatment, periodontal and endodontic infections, and dentoalveolar surgical procedures.
  
  
  CONCLUSIONS
  These cases establish ONJ as a potential complication of bisphosphonate treatment in patients with FD. The presence of established risk factors for ONJ in this group of patients with FD suggests that high-risk patients could be identified before the development of ONJ. Clinicians should use caution in prescribing bisphosphonates to patients with FD and should do so only for established indications.
authors.affiliation: Medical Research Scholar, Section on Skeletal Disorders and Mineral Homeostasis, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD; Dental Student, University of Michigan School of Dentistry, Ann Arbor, MI.
authors.forename: Tarek
authors.initials: T
authors.lastname: Metwally
authors.affiliation: Clinical Research Fellow, Section on Skeletal Disorders and Mineral Homeostasis, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD.
authors.forename: Andrea
authors.initials: A
authors.lastname: Burke
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo, NY.
authors.forename: Jeffrey Y
authors.initials: JY
authors.lastname: Tsai
authors.affiliation: Chief, Section on Skeletal Disorders and Mineral Homeostasis, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Collins
authors.affiliation: Attending Physician, Section on Skeletal Disorders and Mineral Homeostasis, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD; Adjunct Assistant Professor, Division of Endocrinology and Diabetes, and Attending Physician, Bone Health Program, Division of Orthopaedics and Sports Medicine, Children's National Health System, Washington, DC. Electronic address: boyceam@mail.nih.gov.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Boyce
mesh_terms: D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D005357:Fibrous Dysplasia of Bone / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012307:Risk Factors; D055815:Young Adult