Can you use bisphosphonates in a patient with osteoporosis who has had prior avascular necrosis of TMJ due to steroid use?

Due to the rarity of medication-related osteonecrosis of the jaw (MRONJ) and significantly high fracture risk from osteoporosis, prior history of osteonecrosis is not considered an absolute contraindication for bisphosphonate use. The clinical picture is important in weighing this decision. If the patient is very high risk, anabolic therapy is appropriate, with limited bisphosphonate use post-anabolic therapy. If the patient is high risk but without a recent fracture, consideration of short-term oral bisphosphonate may be appropriate, such as a short course of risedronate. The patient should be monitored closely, with close follow-up with dental medicine and oral and maxillofacial surgery (OMFS). It is also appropriate to measure bone turno...