**2. Indications for bisphosphonates**

Even though they were founded in the 18th century, their real clinical usage began only a hundred years ago with the synthesis of the first bisphosphonate (BP)–etidronate. The birthplace of these medicines is considered to be the scientific institute in Davos, Switzerland, where a team headed by Herbert Fleisch, Sylvia Bisaz, and Roman Muhlbauer proved the role of bisphosphonates in bone metabolism and their importance in bone disorders treatment in 1967.

**Figure 1.** Normal osteoclast activity and osteoclasts death by bisphosphonate treatment (after R.E. Marx).

Data concerning pharmacokinetics of diphosphonates, later called bisphosphonates, were published for the first time in 1969. Forty-five years of experience, including researches, has significantly manifested the advantages and disadvantages of this drug group.

Inventing and developing bisphosphonates for treatment of different bone conditions is immense progress in solving fine mechanisms of bone formation and a significant develop‐ ment in medicine as a whole.

Bisphosphonates treatment indications are mainly for increasing bone density in osteoporosis patients (e.g. alendronate and rizedronate), and intravenous (IV) with mouth intake dosage for patients with primary or metastatic bone tumor (e.g. pamidronate and zoledronate). Intravenous intake is also recently tolerated in osteoporosis patients.

**Figure 2.** Scheme of bone metabolic unit (BMU) (after R.E. Marx).

**1. Introduction**

128 Immunopathology and Immunomodulation

sphosphonate therapy.

1967.

avoid bisphosphonate-induced osteonecrosis.

**2. Indications for bisphosphonates**

Since it was first identified in 2003, bisphosphonate-induced osteonecrosis has been under growing control by medical and dental specialist alike because it affects cancer patients re‐ ceiving intra-venous bisphosphonate therapy and osteoporosis patients receiving oral bi‐

It is of significant importance to introduce the mechanism of action of this type of medica‐ tions, way of distribution and risk of complication during or after treatment with them. A strategy of preparation, medication support and techniques before, during and after dental surgery procedures and especially placement of dental implants must be clarified in order to

Even though they were founded in the 18th century, their real clinical usage began only a hundred years ago with the synthesis of the first bisphosphonate (BP)–etidronate. The birthplace of these medicines is considered to be the scientific institute in Davos, Switzerland, where a team headed by Herbert Fleisch, Sylvia Bisaz, and Roman Muhlbauer proved the role of bisphosphonates in bone metabolism and their importance in bone disorders treatment in

**Figure 1.** Normal osteoclast activity and osteoclasts death by bisphosphonate treatment (after R.E. Marx).
