The attacks on Fosamax are beginning to mount. I personally think the fears are grossly unfounded. The risk of osteonecrosis is almost theoretically small. Although Fosamax has not been proven to improve mortality, there is strong data showing that it reduces fractures in those with osteoporosis.
Medicines like ibuprofen kill many more people with GI bleeding – but since Fosamax is made by Merck, it’s easy to kick a horse when it’s down.
Here is what UptoDate says about Fosamax and osteonecrosis:
Osteonecrosis of the jaw (ONJ, avascular necrosis of the jaw), often associated with dental extraction, local infection, and pathologic fracture of the jaw, has been described in patients receiving chronic bisphosphonate therapy. Although most cases have been in cancer patients treated with intravenous bisphosphonates, rare cases have also been noted in patients with postmenopausal osteoporosis taking oral bisphosphonates.
Fosamax continues to be the recommended treatment for osteoporosis.