Oral bisphosphonates (BPs) are used to treat osteoporosis, Paget’s disease, and osteogenesis imperfecta. They are most widely used for treatment of osteoporosis. BP-related osteonecrosis of the jaw (BRONJ) was first reported by Marx in 2003 [1]. The risk of BRONJ in osteoporotic patients treated with BPs remains low compared with that of oncology patients [2]. Recent studies have indicated that the relative incidence of BRONJ in patients with osteoporosis is higher than previously thought [3]. Madrid and Sanz [4] suggested that the placement of dental implants in patients treated with oral bisphosphonates was not associated with the onset of BRONJ; they found no relationship between the treatment and the survival of implants. However, more recently, an increasing number of peri-implant BRONJ cases have been described [5–9]. Peri-implant BRONJ currently is considered an additional complication related to oral implants, along with nerve injury, bleeding, sinus perforation, implant ingestion/aspiration, peri-implantitis, and mucositis [6].

We present a case of a severely osteoporotic woman with BRONJ around her dental implants, who was treated successfully with teriparatide and sequestrectomy.