Article révisé par les pairs
Résumé : Osteoporosis is a frequent condition, leading to a great morbidity and an increased mortality. Efficient treatments are currently available, and allow a significant reduction in fracture rate. Therapy the most frequently used consists of bisphosphonates. Owing to their therapeutic efficacy, million of patients are on bisphosphonate therapy. Osteonecrosis of the jaw has been recently described as complication of adjuvant treatments of cancers by bisphosphonates, notably intravenous ones frequently infused at very high doses. According to the type of cancer, osteonecrosis has been reported in 3 to 10 % of cases. In osteoporosis therapy, a condition in which prescribed doses of bisphosphonates are 10 to 15 times less than in cancer, the frequency is of an order of magnitude of 1 case for 20.000 to 110.000 patient-years of bisphosphonate exposure. Taking into account this frequency, there is no rationale to refuse to osteoporotic patients the potential benefit of this treatment. Precautionously, it is necessary to perform a yearly dental check (as in the general population). If dento-alvelolar surgery proves to be necessary, it is mandatory to perform a less traumatic surgical intervention as possible and avoid infection from the septic oral cavity by thorough closure of the wound. Serum C-telopeptide measurement proposed by several authors is useless. It will be always lowered in case of compliant bisphosphonate therapy. There is no recognized safe threshold value of this biological parameter. Our consensus aims at resetting the risk of osteonecrosis facing the efficacy of osteoporosis treatment. Benefits of therapy far outweigh the potential risks.

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