My post about biphosphonates and osteonecrosis of the jaw (ONJ) drew an interesting comment from Liz, author of a blog devoted to the problem. Concerning my reference to a linked study showing that the major incidence of ONJ is with parenteral biphosphonates in patients with myeloma or metastatic bone disease she states: “That simply isn't true. Oral surgeons and dentists have been seeing patient after patient with jaw necrosis from Fosamax and other bisphosphonate drugs.” Wait a minute. Not so simply, please. According to the systematic review the oncology patients on parenteral therapy represent 94% of published cases despite much heavier use of oral biphosphonates such as Fosamax.
Yes, there are are many “real world” anecdotes about Fosamax, but in order to be convincing Liz should give us a denominator, which I suspect would be huge! Then and only then will we have any idea of the absolute risk for ONJ form oral biphosphonates.