More recently, there has been a new theory proposed based
on the concept that osteoclasts suffer radiation damage earlier
than the development of vascular alterations. It is theorized that
suppression of osteoclast related bone turnover is the initial
event in development of ORN.10–12 Interestingly, the entity
known as bisphosphonate induced osteonecrosis of the mandible
appears to support this theory. Bisphosphonates bind to
bone mineral surrounding osteoclasts and are internalized by
the osteoclasts. This internalization of bisphosphonate disrupts
osteoclast mediated bone resorption, hence osteonecrosis
develops.