NEWS - Jaw osteonecrosis appears to be rare with osteoporosis drugs

September 6, 2006

Jawbone trouble rare with osteoporosis drugs

9/1/2006

By: Reuters Health

NEW YORK (Reuters Health), Sep 1 - Despite reports about the risk of jawbone

deterioration among individuals taking certain osteoporosis drugs, most

patients are not at risk, according to the latest issue of the Harvard

Women's Health Watch.

Yet, since most of the problems have occurred among dental patients, experts

say the best way to guard against osteonecrosis, or the death of jawbone

tissue, is to avoid having to undergo procedures such as dental extractions

and implants.

" The best treatment is prevention, " writes Dr. Celeste Robb-Nicholson,

editor-in-chief of the Harvard publication, urging readers to " practice good

oral hygiene. "

The oral bisphosphonates, Fosamax, Actonel, Boniva, Skelid, and Didronel,

are largely used to treat and prevent the brittle bone disease osteoporosis.

Other more powerful drugs in the same class, Zometa, Aredia, and Bonefos,

are given intravenously and are used to treat bone pain and other

cancer-related bone problems.

The first reports of osteonecrosis among users of the intravenous

bisphosphonate, Zometa, appeared in 2003, according to a report from the

American Dental Association.

The majority of cases were diagnosed after tooth extractions or other dental

procedures were performed. Since then, however, cases of

bisphosphonate-associated jawbone deterioration have also been reported

among individuals taking oral forms of the bisphosphonate medications.

The reason for the association between the bisphosphonate drugs and

osteonecrosis is not entirely known, but researchers speculate it may be due

to the action of the drugs, which decrease the breakdown of bone, thereby

making bones denser in the short term. However, since healthy bone

constantly goes through a process of breakdown and formation (i.e., bone

remodeling), reducing the breakdown of bone also inhibits the formation of

new bone, such as that needed in the jaw after dental extractions or other

trauma.

Considering the large number of women taking bisphosphonates -- the ADA

notes that 22 million prescriptions were written for Fosamax alone between

May 2003 and April 2004 -- the risk of osteonecrosis appears to be extremely

low.

According to an estimate from the ADA, there are only about seven cases per

year occurring among every one million individuals taking the oral drugs.

Those most at risk are cancer patients on intravenous bisphosphonate drugs

since more of the drug is available in the bloodstream when it is given

intravenously than when it is given orally.

" As far as we know today, the benefits of bisphosphonates still outweigh the

risks when they are used appropriately, " Robb-Nicholson writes.

Still, the editor adds, " we can't predict who will develop osteonecrosis of

the jaw. "

To help prevent the condition, Robb-Nicholson recommends that patients

undergo dental extractions or implants before beginning bisphosphonate

therapy or that they inform their dentist before undergoing such procedures

if they have already begun to take a bisphosphonate. That way, the dentist

may opt to preserve a tooth by performing a root canal, which does not

involve any trauma to the bone, rather than an extraction, the editor

explains.

According to Dr. L. sen, a spokesperson from the American Dental

Association, " anybody that's taking any drug should always be aware and

concerned about any potential problems. "

Most people should not be overly concerned about experiencing osteonecrosis

due to their use of bisphosphonates, however, said sen, of the

University of the Pacific in San Francisco, California, and a member of the

ADA's council on scientific affairs.

In fact, he told Reuters Health, the risk of such bone deterioration is

" much less than walking across the street to get lunch " and either tripping

on the street or getting hit by a car.

Still, he added, " take good care of your teeth so you'll never have a

problem. "

By Charnicia Huggins

SOURCE: Harvard Women's Health Watch, September 2006.

Last Updated: 2006-08-31 12:55:04 -0400 (Reuters Health)

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