Clinical Stages of Osteonecrosis Associated with Bisphosphonate Therapy

 

Prerequisite: exposed/visible bone

 

Parameters:

(1) symptoms

(2) complications and/or severe disease

 

Symptoms	Complications	Stage
none	none	I
present	none	II
present	present	III

 

Symptoms may include:

(1) pain

(2) swelling (and signs of inflammation)

(3) foul taste

 

Complications may include:

(1) large area of exposed bone (> 3 cm in maximum diameter)

(2) multiple foci of exposed bone

(3) osteolysis

(4) sequestrum

(5) orocutaneous fistula

(6) pathologic fracture