Bisphosphonates decrease osteoclastic activity and reduce bone resorption, therefore they are used in the treatment of patients with hypercalcemia secondary to malignancy or metastatic bone cancer, Paget's disease and osteoporosis. Recently, cases of jaw bone necrosis have been reported to be associated with the use of bisphosphonates. In patients with rheumatoid arthritis, osteoporosis is frequently developed because of osteoclast activation and steroids which are used for treatment and bisphosphonates are frequently prescribed. A 76-year-old female patient with rheumatoid arthritis was treated with alendronate for the management of osteoporosis for 36 months, and she was presented with pain and swelling on left mandibular area and gingival pus discharge. The patient was treated with curettage of necrotic bone, and biopsy showed avascular necrosis of mandible.

Keywords: Bisphosphonates, Osteoporosis, Rheumatoid arthritis, Avascular necrosis, Mandible