Bisphosphonate Medications and Osteonecrosis of the Jaws- 10 FAQs

Bisphosphonate Medications and Osteonecrosis

                            10 FAQs

 

1. What is Osteonecrosis?  Osteonecrosis of the Jaws is defined as a patient having exposed bone in the mouth that has persisted for more than 8 weeks and is not related to having any radiation therapy to the area.
2. What are bisphosphonate medications used for?  There are two forms of bisphosphonate medications, intravenous and oral.  The I.V. forms( Zometa® and Aredia®) are used to treat cancers that have spread to the bone.  They are effective at minimizing the pain and the calcium imbalance caused when the tumor affects the bone.  The oral bisphosphonates (Fosamax®, Actonel®, and Boniva® are used primarily to treat osteoporosis.  Boniva® is also available in an I.V. form to minimize gastric upset.
3. How do these medications work?  In either form, the bisphosphonate medications work by inhibiting the action of a cell known as an osteoclast.  The osteoclast is the bone cell that "eats up" the old bone and stimulates new bone formation.  When the osteoclast isn't working, old bone just remains and is not remodeled as it is normally.  This can lead to exposure of the bone in the mouth and an inability to heal.  Because the mouth is full of bacteria, the bone often becomes infected and requires extensive treatment.
4. How often does this happen?  The best study to date comes out of Australia where they found that in patients taking the I.V. bisphosphonates the incidence of spontaneous exposure of bone was about one in every 100 cases.  However, after the patient had an extraction, the incidence rose to one in every 11 cases.  In those patients taking the oral form the incidence of spontaneous bone exposure was about 1 in every 10,000 patients and after extraction it rose to about 3 in every 1000 patients.
5. What should I do if I am taking a bisphosphonate medication and I need an extraction or other invasive procedure?  Consult a knowledgeable Oral and Maxillofacial Surgeon who will work with your dentist, dental specialist  and medical doctor to determine the best course of treatment for you.
6. Are there any tests that can be done?  Yes, a test called the CTx measures your body's osteoclast function and it's capability to repair the bone after an extraction?
7. Is there a problem with routine dental care? No cases have been reported due to fillings or routine cleaning.
8. When do these problems begin to appear?  It seems that there is a 3 year threshold for appearance of exposed bone from oral bisphosphonates.  However, this may be accelerated by medications such as Prednisone.  In I.V, bisphosphonate patients the concentration of the medication is much higher so the bone may become exposed within a few months.
9. Should I stop taking my bisphosphonate medication?  ABSOLUTELY NOT!!!!  The incidence of problems from osteoporosis and certainly from bone cancer is much higher than the incidence of osteonecrosis of the jaws.  Your dentist, oral surgeon and medical doctor will work together to determine if you might benefit from a drug holiday.
10. What positive action can I take?  If you are getting ready to begin the I.V. form of the bisphosphonate  for metastatic bone disease you should alert your dentist ASAP so that they can examine your mouth carefully and correct any dental problems.  If you are beginning the oral form for osteoporosis, you should also contact your dentist to advise him or her of this change in your health.  They will very likely ask you to come in for an new exam to assure that no dental problems may be present that could increase the chances of developing osteonecrosis..