A current complex dental issue is the concern about the
bisphosphonates in osteoporosis medications causing "osteonecrosis,"
a rare condition in which healthy jawbone dies (osteo, Latin for bone, and necrosis,
Latin for death or dying). Oral bisphosphonate medications are commonly
taken to prevent or treat osteoporosis or Paget’s disease. The use of intravenous bisphosphonates for
certain cancer patients has been linked to osteonecrosis as well. The occurrence of osteonecrosis is rare, but
a serious condition.
OSTEOPOROSIS
Osteoporosis ("porous bones", from Greek:
οστούν/ostoun meaning
"bone" and πόρος/poros
meaning "pore") is a serious skeletal
disorder that weakens bones and increases the risk of developing fractures. It
affects about 10 million Americans, 8 million of them women. Another 34 million
are at risk of developing osteoporosis. This disorder affects more women than
cancer, heart disease and stroke combined. Many patients are treated with a
group of prescription drugs called "oral bisphosphonates." Examples
include alendronate (Fosamax, Merck & Co., Whitehouse Station, N.J.),
risedronate (Actonel, Procter & Gamble, Cincinnati) and ibandronate
(Boniva, Roche, Nutley, N.J.).
Calcium is an important element needed throughout the body
for muscle and tissue functions. Calcium
blood, muscle, and tissue levels have to be specifically maintained. Bone calcium is used to maintain this balance
by storing and releasing calcium as needed.
Bone calcium is constantly being eaten away and rebuilt within the
skeletal bone. In fact, there is a
complete human skeleton turn over every 3 years. Osteoporosis is a disease in which the boney
release of calcium is greater than the rebuilding of bone, causing defects and
reducing the density of bone.
Bisposphonate drugs patch the boney defects and therefore increase the
bone density.
Correct amounts of daily calcium intake are necessary
through diet and or supplements. 1500 mg
per day is the normal level for healthy individuals. Vitamin D is necessary for calcium
absorption, either through sunlight or supplements. During winter months, it is impossible to
receive enough vitamin D through sunlight north of San Jose, CA.
RISK FACTORS FOR OSTEOPOROSIS
The most important
risk factors for osteoporosis are aging in both men and women. In women, the decrease in estrogen following
menopause is correlated with a rapid reduction in bone mineral density, while
in men, a decrease in testosterone levels has a comparable (but less
pronounced) effect. Also, those with a family history of fracture or
osteoporosis are at a much greater risk for osteoporosis. There are many other risks factors for having
osteoporosis. Some are as follows:
excessive alcohol use, tobacco smoking, poor nutrition, high dietary protein
intake, low weight-bearing inactivity, many medications [particularly steroids
and anticonvulsants], diabetes, and auto immune
diseases.
If you have any of the risk factors for osteoporosis, have
a discussion with your physician and consider having bone density tests.
OSTEOPOROSIS
AND BONE FRACTURES
The risks of osteoporosis, especially the development of
bone fractures, are serious. Fractures of the spinal column and hip are the
most common osteoporosis problems, and hip fractures can be life threatening.
The National Osteoporosis Foundation reports that an average of 24 percent of
patients 50 years and older with hip fractures die within one year of their
injury. One in five patients with a hip fracture ends up in a nursing home. Six
months after experiencing a hip fracture, only 15 percent of patients are able
to walk across a room without help. A woman’s risk of experiencing a hip
fracture is equal to her combined risk of developing breast and ovarian
cancers.
It is estimated that alendronate may reduce by 40 percent
the risk of experiencing a hip fracture in patients with osteoporosis. Thus, it
is possible that the drug could prevent more than 100,000 hip fractures and
tens of thousands of deaths each year. Given the risks associated with
osteoporosis and the proven benefits of oral bisphosphonate therapy, you should
never stop taking these medications before discussing the matter fully with
your physician.
OSTEONECROSIS
OF THE JAW
Jaw complications linked to the use of bisphosphonate
medications are a growing concern. The drugs have been associated with
osteonecrosis of the jaws (ONJ), an uncommon but potentially serious condition
that can cause severe destruction of the jawbones. News reports have alarmed
and confused many patients who receive these drugs to prevent or treat
osteoporosis.
Most cases of ONJ have been seen in patients with cancer
who receive treatment with intravenous bisphosphonates, which absorb
differently from oral bisphosphonates. Intravenous bisphosphonate medications
are use in cancer therapy to reduce bone pain and hypercalcemia (abnormally
high calcium levels in the blood), associated with metastatic breast cancer,
prostate cancer and multiple myeloma.
The true risk posed
by oral bisphosphonates remains uncertain, but researchers agree that it
appears to be very small.
Most cases of osteonecrosis of the jaw associated with
bisphosphonates are diagnosed after procedures such as tooth extraction.
However, the condition can develop spontaneously. Also, invasive dental
procedures, such as extractions or other surgery that affects the bone, can
worsen this condition. Patients receiving intravenous bisphosphonate therapy
should avoid invasive dental procedures if possible. The risk of developing
osteonecrosis of the jaw after dental surgery in patients using oral
bisphosphonates appears to be low.
Symptoms of osteonecrosis include, but are not limited to,
the following:
– Pain, swelling or infection of the gums
or jaw;
– Gums that are not healing;
– Loose teeth;
– Numbness or a heavy feeling in the jaw;
– Drainage;
– Exposed bone.
Because osteonecrosis of the jaw is rare, researchers
cannot yet predict who will develop it. To diagnose the condition, clinicians
may use X-rays or test for infection (taking microbial cultures). Treatments
may include antibiotics, oral rinses and removable mouth appliances. Minor
dental work may be necessary to remove injured tissue and reduce sharp edges of
damaged bone. Surgery typically is avoided because it may worsen the condition.
The consensus is that if you are taking bisphosphonate
medications for osteoporosis or cancer, then good oral hygiene along with
regular dental care is the best way to lower your risk of developing
osteonecrosis.
Enjoy Life and Keep Smiling!
George A. Malkemus, DDS
Dentist in Rohnert Park
2 Padre Parkway Suite #200
Rohnert Park, CA 94928
MalkemusDDS.com
Phone: (707) 585-8595
