The International and American Association for Dental Research has published a major prevalence study and a major case control study showing that the use of oral bisphosphonate drugs such as Fosamax massively increases a patient's relative risk for the development of osteonecrosis of the jaw (literally, "death of the jaw bone"). Published in the Journal of Dental Research April 2011 edition, the article "Risk Factors for Osteonecrosis of the Jaws: a Case-Control Study" shows that Fosamax patients had an odds ratio of 12.2 for the development of osteonecrosis of the jaw: in other words, those patients were more than 1,200% percent more likely to develop osteonecrosis of the jaw than similar patients who were not taking Fosamax. In the same publication, the article "ONJ in Two Dental Practice Based Research Network Regions", revealed that Fosamax patients were 15.5 times more likely (1,550%) to develop osteonecrosis of the jaw than patients who had not taken Fosamax. Fosamax is made by Merck, Sharp & Dohme, out of Rahway, New Jersey. Merck also made the cox-2 inhibitor, Vioxx, which was pulled off the shelves after a study revealed that Vioxx patients' had an odds ratio of 3.0 for the development of adverse cardiovascular outcomes. The Fosamax ONJ odds ratios are much higher than those for the Vioxx heart attack issues.