Update on Osteoporosis Drugs and Dental Treatment

The January 1 issue of the Journal of the American Dental Association reports on a new study showing that the proportion of people taking oral osteoporosis drugs who develop a jaw condition called osteonecrosis of the jaw (ONJ) may be much higher than previously thought. ONJ is characterized by pain, soft-tissue swelling, infection, loose teeth and exposed bone.

Previous reports had indicated that the risk of developing (ONJ) from bisphosphonates in pill form were “negligible,” although there was a noted risk in people taking the higher-dose intravenous form of the drug.

The USC School of Dentistry’s database showed that nine of 208 patients taking Fosamax had active ONJ, a prevalence of about 4 percent. All were patients who had undergone some kind of dental procedure, such as having a tooth removed. The jaw complication has been seen in patients taking Fosamax for as little as one year. It seems to occur most frequently after routine tooth extraction.

Although no one is sure why bisphosphonates seem to have this effect only on jaw bones, the authors speculated that the drugs may make it easier for bacteria to adhere to bone that is exposed after a tooth extraction.

At the USC School of Dentistry patients are put on anti-microbial, anti-fungal rinse one week pre-operatively or post-operatively if they have been on bisphosphonates six months or longer. In my Long Island dental office we routinely ask patients if they are taking osteoporosis drugs and if so, we prescribe the anti-microbial, anti-fungal rinse before we begin dental procedures.

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Several of my long time Long Island dental patients are taking Fosamax or Boniva to prevent further bone loss. No one wants to lose inches or suffer with broken bones. I prefer to manage with regular weight-bearing exercise, a diet rich in fruits and vegetables and calcium supplements but this is up to you and your physician. There has been a lot of talk in the media about a rare condition called osteonecrosis of the jaw which has been linked to use of bisphosphonate medications.

It is important that you distinguish between the bisphosphonate medications (such as Fosamax, Actonel, Boniva) that are taken orally to treat osteoporosis and others (such as Aredia, Bonefos, Didronel or Zometa) which are administered intravenously as part of cancer therapy.

In rare instances, some individuals receiving intravenous bisphosphonates for cancer treatment have developed osteonecrosis of the jaw, or destruction of the jawbone. Still more rarely, osteonecrosis of the jawbone has occurred in patients taking oral bisphosphonates.

Patients currently receiving intravenous bisphosphonates should avoid invasive dental procedures if possible. The risk of osteonecrosis of the jaw in patients using oral bisphosphonates appears to be low, but be sure to let your dentist know if you use any bisphosphonate medication. It is up to you and your physician whether to modify use of the bisphosphonate medication before dental surgery procedures. The consensus is that good oral hygiene and regular dental care will help to lower your risk of developing osteonecrosis.download desperado dvd

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