Out of every 20 reported cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ, ONJ, or BON), only 1 of those 20 cases involved the use of bisphosphonates for the treatment or prevention of osteopenia or osteoporosis. The other 19 cases involved the use of bisphosphonates for the treatment of various cancers. Between 5% and 11% of all patients treated for cancer (with high-dose intravenous bisphosphonates) developed osteonecrosis of the jaw, while the rate for patients treated for osteopenia or osteoporosis (with low-dose oral bisphosphonates) may have been as low as 1 person in 100,000 person-years of exposure. Things that would increase a person's risk of developing osteonecrosis of the jaw include: (1) Head or neck irradiation, (2) Trauma, (3) Periodontal disease, (4) Local cancer malignancy, (5) Chemotherapy, (6) Glucocorticoid (corticosteroid) therapy, (7) Old age, (8) Female gender, and (9) Intravenous bisphosphonate administration instead of oral administration. Nearly one-third of all victims of osteonecrosis of the jaw reported having a history of glucocorticoid use. More than two-thirds of all victims reported a tooth extraction or other surgical or invasive dental procedure as the inciting event which triggered their osteonecrosis of the jaw. In conclusion, my advice to those who have elected to treat their osteopenia or osteoporosis with bisphosphonates is: (1) Minimize your risk of developing osteonecrosis of the jaw by finishing all of your dental work before beginning treatment, and (2) Even though intravenous administration increases your risk of developing osteonecrosis of the jaw when compared to oral administration, go with intravenous Boniva (ibandronate) injected once every 3 months or intravenous Reclast (zoledronic acid) injected once every 1 year because recent studies indicate that the less frequently a bisphosphonate is administered, the more likely that the patient will tolerate the drug and agree to keep on receiving the drug and happily go on to reduce future fractures by about 50%. Remember that about half of all people will decide to discontinue treatment with bisphosphonates because of substantial side effects. The following 14 PubMed studies discuss bisphosphonate-related osteonecrosis of the jaw: http://www.ncbi.nlm.nih.gov/pubmed/18767452 http://www.ncbi.nlm.nih.gov/pubmed/19371813 http://www.ncbi.nlm.nih.gov/pubmed/19286860 http://www.ncbi.nlm.nih.gov/pubmed/18447663 http://www.ncbi.nlm.nih.gov/pubmed/17599853 http://www.ncbi.nlm.nih.gov/pubmed/18528958 http://www.ncbi.nlm.nih.gov/pubmed/18403302 http://www.ncbi.nlm.nih.gov/pubmed/19484166 http://www.ncbi.nlm.nih.gov/pubmed/19478642 http://www.ncbi.nlm.nih.gov/pubmed/19536938 http://www.ncbi.nlm.nih.gov/pubmed/18501224 http://www.ncbi.nlm.nih.gov/pubmed/19371819 http://www.ncbi.nlm.nih.gov/pubmed/19446234 http://www.ncbi.nlm.nih.gov/pubmed/18201600 The following PubMed study says that if you develop osteonecrosis of the jaw, there is only an 18% chance that it will completely heal and a 52% chance that it will only partially heal with long-term antibiotic therapy: http://www.ncbi.nlm.nih.gov/pubmed/19304045 Finally, the following June, 2009 Pubmed study says Reclast (zoledronic acid) substantially outperformed the other 3 bisphosphonates in vertebral fracture prevention: http://www.ncbi.nlm.nih.gov/pubmed/19530978
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Minimizing the risk of bisphosphonate-related osteonecrosis of the jaw
- By rmchavin
- Posted June 22, 2009 at 6:43 pm · 8 replies
- In Osteoporosis medications
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- Edited June 22, 2009 at 8:27 pm
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Exercise Cancer Teriparatide Brushing Ibandronate Osteopenia Chemotherapy Gum disease Osteoporosis Evista Osteonecrosis Boniva Zoledronic acid Forteo Fractures Diabetes Reclast Raloxifene Constipation
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- By a1b2c3
- Posted June 25, 2009 at 7:29 pm
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You're recomendation to " have your dental work before you begin treatment with bisphosphonates seems a bit off the cuff. If your tooth goes bad after you begin, should you ignore it? None the less, the article was interesting and thanks for posting it.
- By rmchavin
- Posted June 26, 2009 at 8:44 am
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Dear a1b2c3:
Did you know that people with diabetes need to keep testing their blood for HbA1c (hemoglobin A1c)? HbA1c gives a better indication of how severe their diabetes has gotten than the fasting blood glucose reading, which can easily be manipulated by what they ate recently or how little they slept the prior night. HbA1c can be thought of as the average of all the fasting blood glucose readings for the last 3 months. HbA1c cannot be manipulated by the patient to fool the doctor for the purpose of short term deception. Anyhow, yes, it is a good idea to see your dentist and try to get all of your dental work (especially tooth removal) done and out of the way, if for no other reason than the psychological benefit of doing so. You asked, "If your tooth goes bad after you begin, should you ignore it?" That depends on several things. Does it require pulling the tooth out to prevent brain damage from gum disease? Or are you just reglueing a crown (cap) on a tooth? Are you taking the bisphosphonate intravenously or orally? (Actually, you ought to be brushing your teeth during bisphosphonate treatment more frequently than you normally would to prevent any chance of having to pull out any teeth).
- By SusanUSA
- Posted June 26, 2009 at 10:03 am
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From your posting, It seems I had better continue to stay away from treatment with zolendronic acid. From the dental surgeons I trust at Eastman's Dental hospital, the risk of osteonecrosis of jaw is too real in my case (ongoing periodontal disease & 2 extractions so far!) But my last dexa scan showed deterioration in lumbar spine (after 3 years pamidronate infusions & continued exercise). Is there any safe treatment for Osteoporosis - natural / alternative or straight medical?!
- By rmchavin
- Posted June 26, 2009 at 3:48 pm
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Dear SusanUSA:
Intravenous Aredia (pamidronate) is a bisphosphonate. You are already receiving intravenous bisphosphonate treatment. Cancer patients receiving ultra-high doses of intravenous bisphosphonates have about a 10% chance of developing osteonecrosis of the jaw. But only about 20% of cancer patients have teeth that might need to be pulled out. If I were you, I would choose Forteo (teriparatide), Miacalcin (salmon calcitonin), Protelos (strontium ranelate), and/or Evista (raloxifene) next. I would do all my tooth pulling about one year after beginning treatment with one or two of those drugs. I would reconsider receiving the bisphosphonate, intravenous Reclast (zoledronic acid), injected once every 1 year, only well after all my tooth pulling was definitely completed and out of the way.
- By willamette
- Posted June 26, 2009 at 6:42 pm
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That is one of the big problems. People like myself, have on going dental problems. It is not a simple matter of getting your dental work done first. Tired of hearing that comment. It is not that simple.
- By sdivas
- Posted June 26, 2009 at 7:57 pm
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Hello willamette, I share your interest and love of pet rescue. Regarding dental concerns: Most dentists should now be aware with the brochure available for dentists through the ada (American Dental Association). I continually bring osteoporosis awareness to my dentist along with my concerns. I have dental cleaning every three months; I have thorough under gum treatment approximately every 5 years. Before any dental procedure, I am given an antibacterial treatment; also after the procedure. Three of my front teeth were not as strong due to residing gums. My dentist and I discussed options and decided on bonding the three teeth. So far, over the last 5 yrs, the bonding has held and the teeth remain strong. I've had crown work done without any side effects. I make my dental appointments in the morning, with the option of returning in the afternoon or within days if I have any problems. I think the only thing we can do as dental patients is communicate our concerns with our dentists. Request that precautions are taken with dental procedures. The dentist and the patient should work as a team; especially with a health concern. We can only do so much and the rest is out of our control. But we are individuals; not studies. Information is important to have, but must be put in perspective.
- By willamette
- Posted June 26, 2009 at 11:13 pm
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Hi
Thanks for the info. I know my dentist said bisphosphonate's are a real problem. I was taking Salmon Calcitonin , but it gave me such severe constipation I had to quit taking it. But I might try again with psyllum Husk tablets, and see what happens. I am terrified of any of the others drugs. It is scary. Thanks again for your input, very appreciated!!
Glad you care abut animals also....
- By vflorence
- Posted July 24, 2009 at 1:33 pm
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I am about to have FREE GRAFTING done to reverse gum recession ( I am at a level 5 in this area -- tooth # 20). My teeth / bones are strong. This dental outpatient procedure consists of having palate tissue grafted on to the recessed area to reverse the condition.
Since I have reversed my Osteoporosis down to normal or Osteopenia levels, I am wondering if I should go on a "drug holiday" for the duration of this grafting- treatment--- date is in September and I am having the procedure done at a well regarded Boston dental school. Any thoughts, anyone ?
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