Bisphosphonates have been around for a while and there is a lot of recent publications in our journal associating bisphosphonates to ONJ. What needs to be done and what is currently in the works is a big multicenter retrospective study. The risk of developing ONJ is more closely linked to the newer generation bisphosphonates pamidronate and zolendronic acid. Fosamax is usually given in PO form and from the studies I have read through has only shown 1 or 2 case reports. It will be interesting to see what the bigger mulitcenter trial study shows because bisphosphonates are commonly used not only to treat osteoporosis but hypercalcemia from bone mets seen in breast CA, prostate CA...ect.
The other problem is that there is no overall defenitive tx for those who are diagnosed with ONJ from bisphosphonates. One tx has not been shown to help in all cases. Some have tried local debridement, HBO therapy, and more aggressive resection. For now the goal should be to have patients screened before undergoing tx with IV bisphosphonates just as patients are screened prior to undergoing radiation therapy.
I doen't think anyone would disagree with you above. Anecdotally we have seen numerous cases here, typically we treat them with a marginal resection with a plate or a very large local debridment with a bur. kinda like ORN without the HBO.