Bone resorption inhibitors and maxillary osteonecrosis

Bone resorption inhibitors such as bisphosphonates and denosumab have transformed the management of many bone diseases, including osteoporosis, bone metastases and certain malignancies. However, their use is associated with a dreaded adverse effect: osteonecrosis of the maxilla (ONM), a rare but potentially severe complication.This chapter explores the pathophysiological mechanisms behind this complication, the risk factors (route of administration, duration of treatment, local cofactors such as dental extractions or infections), and current recommendations for prevention, diagnosis and management.Particular attention is paid to the distinction between forms of ONM according to therapeutic indication (osteoporosis vs. cancer), as well as to the latest recommendations from learned societies. The approach is based on close collaboration between the prescriber, the dental surgeon and the patient, in order to limit risks while maintaining optimum quality of life.