American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following can occur as a side effect of bisphosphonates?

1. Hypoglycemia

2. Osteonecrosis of the jaw

3. Hemolytic anemia

4. Severe dehydration

The correct answer is: Osteonecrosis of the jaw

Bisphosphonates are a class of medications commonly used to treat conditions associated with bone resorption, such as osteoporosis and certain malignancies. One of the notable side effects associated with bisphosphonate therapy is osteonecrosis of the jaw. This condition, characterized by the death of bone tissue in the jaw, often arises in patients undergoing bisphosphonate treatment, particularly those who have received intravenous formulations for cancer-related indications. The risk of developing osteonecrosis of the jaw is especially heightened in patients undergoing dental procedures while on these medications or in those with other risk factors such as poor oral hygiene or pre-existing dental disease. The exact mechanism by which bisphosphonates contribute to this condition is not entirely understood but may involve suppression of bone remodeling and a reduction in the healing capacity of the affected area. In contrast, the other options listed do not typically correlate with bisphosphonate use. For instance, hypoglycemia is generally associated with diabetes medications, hemolytic anemia is more related to specific triggers like certain infections or drug reactions, and severe dehydration can result from numerous factors unrelated to bisphosphonates. Therefore, knowing that osteonecrosis of the jaw is a well-recognized side effect of bisphosph