Bisphosphonate osteo-necrosis of the jaws [BONJ], from defective function of oral epithelial intercellular junctions?

Bone osteonecrosis of the jaws (BONJ) is prevalent when diseases are treated with high bisphosphonate doses. The mouth is unique in that it has epithelial covered bony protuberances jutting into an infective environment. Should epithelium over these bony prominences be disrupted, abraded or ulcerated by trauma, extraction or therapy, not only will the mucosa not heal, but in vulnerable cases, where less-vital bone is present, there is development of BONJ. BONJ development is explained by BP's depleting available calcium ions from healthy functioning of epithelial gap junctions and disrupting the balance between osteogenesis and osteoclasis.