Risk Factors in the Development of Oral Bisphosphonate-induced Osteonecrosis.

Bisphosphonates (BPs) are routinely prescribed to prevent pathologic fractures in osteoporotic patients. Bisphosphonate-associated osteonecrosis of the jaw (BRONJ) is a rare, but serious complication, most often following extraction in patients treated with intravenous BPs. We report a case of BRONJ in a patient following six years of oral BP administration for the management of osteoporosis, complicated by four years of prednisone therapy for pulmonary fibrosis. This rare presentation led us to investigate other causative factors, in particular, glucocorticoids. This report aims to construct a clinically relevant predictive model of the disease through better understanding of concomitant risk factors.