The risk of developing BRONJ associated with oral bisphosphonates, while exceedingly small,
appears to increase when the duration of therapy exceeds three years. This time frame may be
shortened in the presence of certain comorbidities, such as chronic corticosteroid use. If systemic
conditions permit, the clinician may consider discontinuation of oral bisphosphonates for a
period of three months prior to and three months following elective invasive dental surgery in
order to lower the risk of BRONJ. The rationale for this approach is based on extrapolated data
that demonstrate fluctuations of osteoclast function, which is related to bisphosphonate therapy,
and recent outcomes studies that show improved outcome of BRONJ treatment with drug
cessation.Long-term, prospective studies are required to establish the efficacy of drug
holidays in reducing the risk of BRONJ for patients receiving oral bisphosphonates. The risk
reduction may vary depending on the duration of bisphosphonate exposure. Modification or
cessation of oral bisphosphonate therapy should be done in consultation with the treating
physician and the patient.