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February 22, 2019
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Osteoporosis, osteonecrosis and dental health

By: George Malkemus
September 28, 2018

A current medical and dental concern is the use of bisphosphonate medications causing osteonecrosis of the jawbone, a rare condition in which bone in the jaw dies (osteon, Latin for bone, and necrosis, Latin for death or dying). Oral bisphosphonate medications (pills that are taken by mouth) are commonly taken to prevent or treat osteoporosis or Paget’s disease. Luckily, the oral use of bisphosphates is rarely found to cause osteonecrosis. The use of intravenous bisphosphonates for certain cancer patients has been more often linked to osteonecrosis. Though the occurrence of osteonecrosis is rare, it can be a grave condition with limited treatment success. Osteoporosis Osteoporosis is a serious skeletal disorder that weakens bones and increases the risk of developing fractures. It affects about 10 million Americans, 8 millions 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, Genentech, South Francisco, CA.). Osteoporosis and bone fractures There are serious problems caused by osteoporosis, especially the development of bone fractures. Fractures of the spinal column and hip are the most common osteoporosis problems. 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 has been estimated that patients with osteoporosis reduce the risk of experiencing a hip fracture by 40 percent when taking Alendronate. 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. Most cases of ONJ have been seen in patients with cancer who receive treatment with intravenous bisphosphonates, which are absorbed differently from oral bisphosphonates. Intravenous bisphosphonate medications are used in cancer therapy to reduce bone pain and hypercalcemia (abnormally high calcium levels in the blood), which is 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 occur after dental surgical procedures such as tooth extractions. However, the condition can develop spontaneously. Patients receiving intravenous bisphosphonate therapy should avoid surgical dental procedures if possible. The risk of developing osteonecrosis of the jaw after dental surgery in patients taking an oral pill form of bisphosphonates is very 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. Because it may worsen the condition, surgery is avoided if at all possible. If you are taking bisphosphonate medications for osteoporosis, Paget’s disease or cancer, the best way to lower your risk for developing osteonecrosis is by having good oral hygiene habits, brushing and flossing, along with regular dental appointments for dental exams and cleanings. Enjoy Life and Keep Smiling! George Malkemus has had a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@ malkemusdds.com. Visit Dr. Malkemus’ Web site at http://www.malkemusdds.com