RESEARCH - Oral bisphosphonate use linked to jaw osteonecrosis

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Oral Bisphosphonate Use Linked to Jaw Osteonecrosis

NEW YORK (Reuters Health) Jan 09 - Oral treatment with the

bisphosphonate alendronate (Fosamax, Merck) for as little as 1 year

increases the risk for osteonecrosis of the jaw following certain

dental procedures, according to a study conducted at the University of

Southern California School of Dentistry in Los Angeles.

Bisphosphates have a half-life in bone that spans years and are

believed to disrupt osteoclast function leading to apoptotic cell

death, lead author Dr. Parish P. Sedghizadeh and colleagues explain in

the January issue of the Journal of the American Dental Association.

Originally thought to pose a risk only when used intravenously, new

evidence has suggested that oral bisphosphonate use may be involved as

well.

To determine the extent of the association, Dr. Sedghizadeh's team

analyzed electronic medical records at their institution. They found

that, of 208 patients with a history of oral alendronate use, 9 (4%)

had active jaw osteonecrosis. All affected patients were women, ages

63 to 80, who had used alendronate 70 mg orally once per week for 12

to 120 months.

" We've been told that the risk with oral bisphosphonates is

negligible, but four percent is not negligible, " Dr. Sedghizadeh said

in a press release.

Four cases developed following tooth extractions and five were

associated with denture-related mucosal ulceration. All cases but one

involved the mandible. None of these patients had been referred for

evaluation or treatment of osteonecrosis.

By contrast, among 13,522 patients without a history of alendronate

use, including 32% who underwent dental extractions, no cases of jaw

osteonecrosis were identified.

The authors suggest that for patients taking a bisphosphonate,

" alternate treatment options may be considered for use for

nonnecessary extractions, and good oral hygiene should be achieved

before necessary extractions to minimize microbial load. " They also

propose using chlorhexidine rinses to ensure socket and wound healing

and mucosal coverage of exposed bone.

The researchers recommend updating dental surgery consent forms to

warn patients on bisphosphonate therapy that they may be at risk of

developing osteonecrosis of the jaw.

Finally, Dr. Sedghizadeh and associates call for larger, prospective

studies to confirm their single-institution findings.

J Am Dent Assoc 2009;140.

http://www.medscape.com/viewarticle/586519

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