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Bisphosphonate drugs is a class of
drugs use to treat certain disease states. The drug is administered orally or
intravenously. The IV route medications (Zometa and Aredia) are used to treat
primarily metastatic cancer and multiple myeloma. The oral medications are
(Fosamax, Actonel, and Boniva) used primarily in the treatment of
osteoporosis. |
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Bisphosphonate drugs work by
inhibiting osteoclasts. This results in increased bone density. It also results
in a gradual reduction in the bone turnover rate or ability to make new
bone. |
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Osteoporosis is diagnosed by a DEXA
Scan. It is a disease state where bone has lost mineral, mass and structure
making them weaker and at increased risk for fracture. Osteoporosis occurs in
20-30% of post-menopausal women, it occurs in 13% of men over 50 and 50% in
women over 60 years old. It also occurs earlier and more severely in women of
Northern European descent. |
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Bisphosphonate associated
osteonecrosis of the jaw (BONJ) is dead bone associated with taking
bisphosphonate drugs. When associated with IV bisphosphonates the dead bone can
be expected to never resolve. To date no effective treatment has been
discovered. No surgery has been found to be curative. BONJ can occur with in
5-6 doses but usually is associated with invasive dental procedures. |
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BONJ when associated with oral
medications has shown to be less severe and with cessation of the medication to
resolve spontaneously 60% of the time. The greatest risk factors appear to be
length of time on the medications and simultaneous use of steroids. Persons on
the oral bisphosphonates less than 3 years and otherwise healthy have minimal
to no risk of BONJ with procedures such as extraction of teeth |
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Does everyone on the bisphosphonates
get BONJ? The answer is no. The incidence is certainly low but the number of
cases reported is increasing. The longer people are on the medication the
greater the risk when invasive dental procedures are done. |
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How do we prevent BONJ? The best
course is to have ALL invasive dental work done prior to starting either IV or
oral bisphosphonates. Once dental health is established then your risk of BONJ
is dramatically reduced. Keeping your dental health is obviously very important
when you are taking these drugs. |
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If an invasive procedure is needed
when on IV bisphosphonates try to avoid the procedure. If procedure is needed
while on oral bisphosphonates and on for more than 3 years then a consultation
with dentist and physician is indicated to establish a time frame for taking a
"drug holiday" and evaluating the bone's ability for turnover utilizing a blood
bone marker test. Alternative treatments may be indicated such as Evista,
Forteo, and Miacalcin. |
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If you have an area of exposed bone
then consultation with the treating dentist/oral surgeon is indicated. |
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