The number of reports of patients receiving bisphosphonates for multiple myeloma (MM) or other types of cancer who have developed osteonecrosis of the jaw is increasing. Two new sets of practice guidelines for bisphosphonate therapy have been published recently, one in the Mayo Clinic Proceedings (2006; 81:1047-1053), the other in the Journal of Oncology Practice (2006; 2:7-14).

The Mayo Clinic guidelines focus on patients with MM, recommending that:
• Patients with MM and lytic disease should receive IV bisphosphonates, administered monthly for 2 years
• Patients who achieve a response after 2-year bisphosphonate therapy should discontinue the drug
• After 2 years, bisphosphonate infusions should be titrated down to every 3 months
• Patients with MM and concomitant osteopenia or osteoporosis but no lytic disease should be started on IV bisphosphonates
• Bisphosphonate therapy is not recommended in patients with smoldering MM.

The second set of recommendations, issued by a group of dental, endocrinology, and oncology experts, focuses on the prevention and treatment of jaw osteonecrosis in patients with cancer, suggesting: 
• Considering alternative preventive measures before starting IV bisphosphonate therapy
• Routine clinical dental exams
• Preventive dentistry before beginning bisphosphonate therapy
• Regular dental assessments after initiation of bisphosphonate therapy
• Consultations between all the treating physicians
• Consideration of prophylactic antibiotic therapy to protect exposed bone/adjacent tissue.