Sunday, January 06, 2008

Jaw problems with oral meds for osteoporosis

Pictures of osteonecrotic jaws are the sorts of displays that separate those destined for medical careers from those who would pass (or rather pass out). For that reason, I am not including a picture with this post, but, believe me, you do not want this to happen to your jaw.

In the past 5 years, a correlation has been noted between dead bone in the jaw causing separation and loss of teeth and the use of IV bisphosphonates (we will call this bisphosphonate-associated osteonecrosis of the jaw: BON). These drugs in their oral form, including Boniva, Fosamax, and Actonel, are used to prevent or treat osteoporosis. The IV forms--particularly Zometa and Aredia--are used in cancer treatment to slow tumor spread to bone, reduce bone pain from metastases, and decrease the high calcium levels that can result from bony involvement. They are very useful in this regard, and the risk of BON, while low, is not spontaneous but almost always associated with dental procedures such as extractions.

Oral bisphosphonates are increasingly favored as non-hormonal solutions to post-menopausal bone loss, but the possibility that their use could lead to an icky jaw situation of the BON-ish variety has left me somewhat reluctant to embrace their use. I was greatly relieved, therefore, to come across a report from the January edition of the Journal of the American Dental Association. This review of claims data for over 700,000 cases of osteonecrosis of the jaw confirmed that IV bisphosphonates indeed increase the risk of dead jaw bone by a factor of four or more. The good news, however, is that oral bisphosphonates such as Fosamax and Actonel were actually noted to decrease the risk of osteonecrosis in patients with osteoporosis by 1/3.

To review, osteonecrosis is dead bone. You don't want that in your jaw. Osteoporosis is thin bone. You don't want that anywhere. If you take oral medications such as Fosamax, Actonel, or Boniva to avoid thin bone, you do NOT increase your risk of dead bone lifting your teeth out of your mouth.

1 comment:

Ruth said...

Interesting. I remember reading somewhere that dental Xrays can reveal early osteoporosis. My m-i-l had severe osteoporosis and lost several complete teeth before she fractured her spine, hip and humerus in several falls. She was never treated pharmaceutically for osteoporosis until after her last fracture.