"Another important aspect only briefly mentioned in the editorial, and one that I think should be kept in mind, is the fact that in the case series of both Marx2 and Ruggiero et al,3 there were a total of 8 cases of noncancer patients taking a less potent type of bisphosphonate for the treatment of osteoporosis. I am certain that other similar cases will soon be reported. If we consider that a large number of individuals around the world are using bisphosphonates for prevention or treatment of osteoporosis, we may be dealing with a significant potential complication. I would think twice before giving oral implants to a patient being treated with a bisphosphonate until we learn more about the mechanisms involved in the formation of osteonecrosis.
Last but not least, Dr Greenberg ends the editorial calling for research, oral examinations before placing the cancer patients on therapy with bisphosphonates, and improved communication with dentists and medical oncologists. I would like to refer Dr Greenberg and the readers of OOOOE to a letter to the editor that we published last year in the Journal of Clinical Oncology.4 This was the first report of such cases of osteonecrosis and bisphosphonates in the medical literature. As a dentist dealing with such complications I felt that the first communication of this complication should reach those who prescribe the medications."
Cesar Augusto Migliorati, DDS, MS, PhD
Nova Southeastern University, College of Dental Medicine, Fort Lauderdale, Fla
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