Oral bisphosphonates are the most commonly prescribed antiresorptive drugs for the treatment of osteoporosis. However, there are several adverse effects associated with oral bisphosphonates including the bisphosphonate related osteonecrosis of the jaw (BRONJ). With a better understanding of this side effect, reported incidences for BRONJ in oral bisphosphonate users have increased in time. The pathogenesis of BRONJ has not been well determined. Several risk factors such as dentoalveolar surgery, therapy duration, and concomitant steroid usage have been linked to BRONJ. Conservative and surgical methods can be preferred in the treatment. Preventative measures are of great importance for the patients at high risk. In this paper, osteonecrosis of the jaw secondary to oral bisphosphonates was reviewed in order to increase awareness as well as to renew the current knowledge. 1. Introduction Oral bisphosphonates are synthetic drugs used primarily in the treatment of osteoporosis [1]. Since osteoporosis is the most common metabolic bone disease worldwide, there has been a remarkable increase in the prescription of the antiosteoporotic drugs including the bisphosphonates [2]. Being strong suppressors of osteoclasts, bisphosphonates slow the remodeling process and thus increase bone mineral density. Presently approved bisphosphonates for the treatment of osteoporosis have been shown to notably decrease the risk of fractures due to osteoporosis. Because of their confirmed effectiveness, bisphosphonates are considered as first line therapy in the treatment of osteoporosis and are the most widely prescribed antiresorptive agents [3]. Despite the benefits of these drugs, bisphosphonate related osteonecrosis of the jaw (BRONJ) which was first published in the literature in 2003 is a severe side effect of bisphosphonate therapy [4–7]. Since this initial identification, many cases have been reported [8–11]. 2. Definition In order to discriminate BRONJ from other conditions The American Society for Bone and Mineral Research define BRONJ as follows [12]. Patients may be considered to have BRONJ if they have all of the following criteria.(1)Current or previous treatment with a bisphosphonate; (2)exposed bone in the maxillofacial region that has persisted for more than eight weeks; and (3)no history of radiation therapy to the jaws. However, stage 0 BRONJ where there is no exposed bone is not compatible with this definition. Therefore an update of the definition was performed as “exposed or otherwise necrotic bone” [13]. 3. Pathogenesis Despite the possibly linking
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