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Dental Prevention Treatment Suggested For Those On Bone-Loss Drugs

Posted by Jane Akre
Friday, January 02, 2009 12:38 PM EST
Category: Major Medical, Protecting Your Family
Tags: Bisphosphonates, Fosamax, Boniva, Actonel, Osteoporosis, FDA and Prescription Drugs

Bisphosphonates for bone loss seen in a dental clinic to cause jaw necrosis.



IMAGE SOURCE: Zometa  Web site


Bone loss among post-menopausal people is very common and so are prescriptions for bisphosphonates, which slow bone loss and rebuild bone in those facing osteoporosis.

Previous studies had indicated that the risk of developing a jaw condition, ONJ, or osteonecrosis of the jaw that loosens teeth and softens bone, was negligible, particularly among those taking a pill versus IV delivery of bisphosphonates.

A new study suggests the jaw condition might be more common than previously thought. 

Dr. Parish Sedghizadeh at the University of Southern California School of Dentistry in Los Angeles, reports his clinic was seeing from one to four new cases a week, reports the Washington Post

In an effort to find out why, he and colleagues studied the records of 208 patients from the USC School of Dentistry’s electronic database. 

Nine of the patients taking Fosamax had active ONJ – about 4 percent.  These patients were having dental issues and had been at the School of Dentistry.

The result of his findings is published in the January 1 issue of the Journal of the American Dental Association. 

Bisphosphonates, such as Actonel, Aredia, Boniva, Didronel, Fosamax and Fosamax PlusD, Reclast, Skelid and Zometa - are a class of drugs that slow or stop reabsorption of bone.

They can reduce the risk of bone fracture, and in some cases can increase bone mass in those with osteoporosis. In cancer patients, they slow bone turnover in people with cancer of the bones or multiple myeloma.

An estimated 1 in 10 cancer patients who receive treatment with IV bisphosphonate drugs will develop the jaw problem.

In the past, ONJ has been seen in patients taking Fosamax, the most widely prescribed bisphosphonate,  even after taking the drug for as little as one year and generally after tooth extraction. Fosamax, marketed by Merck & Co., has been on the market since 2006.

USC now screens all dental patients for bisphosphonate use.

Sedghizadeh says, "We put patients on anti-microbial, anti-fungal rinse one week pre-operatively or post-operatively. If they have been on bisphosphonates six months or a year or longer, then we have a prevention protocol which has been very, very effective."

Dr. Sedghizadeh speculates that the drugs may make it easier for bacteria to adhere to the exposed bone after a tooth extraction.

Merck says the study has flaws and scientific limitations, making it unreliable.

Other risks associated with bisphoshonates are atrial fibrillation (an abnormal heart rhythm), unusual fractures of the thigh bone, and inflammatory eye disease.

In an alert posted on its website last year, the FDA is warned that patients treated with many of the commonly used osteoporosis drugs occasionally develop disabling pain that doctors may not be linking to the drug's use.

The pain usually strikes the muscles, joints and bones and is a previously known risk included in the warning label. Few patients report the muscle and joint pain within days months or years after taking the bisphosphonates. In some rare cases the pain is reported to be "incapacitating" for normal movement like walking. #

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