The AAOMS recently released a position paper about medication-related osteonecrosis of the jaw (MRONJ). Bisphosphonates are the most common class of medication associated with MRONJ. The definition has been expanded, however, and now includes medications taken by more than 5.1 million people over the age of 55. Dental procedures which expose and/or damage bone have the potential to cause osteonecrosis for these patients.  The highest risk category is IV cancer therapy, which is about 100 times higher than patients being treated for osteoporosis.  Patients taking oral bisphosphonates for greater than 4 years are at an increased risk and should consult with their physician regarding a 2 month drug holiday prior to invasive treatment such as extraction. Patients should be treated aggressively prior to, and direct osseous injury should be avoided during, IV therapy. This could mean root canal treatment in lieu of extraction, if they are high risk. I highly encourage you to review the paper itself, as there much more information provided there.