The association of glucocorticoid use, low bone mineral density (BMD), and osteoporotic fracture is well established. However, the use of bone-protective measures for users of glucocorticoids has traditionally been sub-optimal. The 1996 American College of Rheumatology Guidelines recommend routine BMD testing and liberal use of anti-osteoporosis medications in chronic glucocorticoid users, yet the effectiveness of these recommendations in clinical practice have not been systematically evaluated.
Gastrointestinal complications, including esophageal mucosal ulceration, are the most frequent complications of bisphosphonate therapy, commonly used to treat osteoporosis, metabolic bone diseases (such as Pagets disease), multiple myeloma, and to inhibit metastatic solid tumor progression. Recent case reports have emphasized a less frequent complication of bisphosphonate therapy: osteonecrosis of the jaws. However, due to its rarity, little is know about the epidemiology of this potentially troublesome complication.