Which patient group is most at risk for osteonecrosis of the jaw related to bisphosphonates?

• A. Cancer patients receiving intravenous bisphosphonates
• B. Children taking vitamin D
• C. Healthy adults taking calcium
• D. Pregnant women

Answer: (A)

The key idea is understanding who faces the highest risk of osteonecrosis of the jaw when using bisphosphonates. Osteonecrosis of the jaw occurs when bone healing is impaired after dental injury or procedures, and bisphosphonates suppress bone turnover. This suppression is far stronger and more prolonged with high-dose intravenous bisphosphonates used in cancer care than with the oral forms given for osteoporosis, making cancer patients receiving IV therapy the group most at risk. In contrast, vitamin D in children, calcium in healthy adults, and pregnancy do not involve high-dose IV bisphosphonate exposure, so their risk is much lower; pregnancy also raises other safety concerns and bisphosphonates are generally avoided.