Drug Holiday for Biphosphonates

[RobinP]

Just want to let others know that one of the recent articles in the NEJM eludes to that fact that once someone has been on five years of biphosphonates, the suggestion of a one year drug holiday has been recommended. See excerpts from the article, Osteonecrosis of the Jaw- Do Bisphonoaes Pose a Risk? by Bilezikian, MD

The possibility that the risk of osteonecrosis of the jaw may be increased with the duration of therapy has led some to emphasize the need for a "drug holiday" for patients who are being treated with bisphosphonates for osteoporosis — perhaps a 1-year period without bisphosphonate therapy after 5 or more years of treatment. Clearly, more research is needed to clarify the magnitude and basis of the risk of osteonecrosis of the jaw associated with the dose of bisphosphonates and the duration of their use.

[R.B.]

Omega threes and bone density / rebuilding

There is some suggestion in various trials that omega three impact postivley on bone density - I think I posted them under Greek Diet but you should be able to find them by searching using the facility above.

RB

[RobinP]

Thanks RB, here's a few other:


Natural Remedy suggestions for bone mass building:

Avoid the following which destroy calcium balance and bone building:
antacids
steriod drugs
alcohol
smoking
coffee
sodas-due to too much phosphorus content, disrupts the ca. balance.
diuretics


Take the following remedies to build bone mass
vit D and vit K daily
calcium 1200-1500mg daily
boron
magnesium
phytoestrogens like soy may build bone mass if you're not too leary to try with a bc history.
(OMega 3 balancing)

COllagen builders helps build bone- collagen is the glue that holds bone together:
zinc
vit a
vit c

Finally- Uses em or lose 'em
weight bearing exercise 20-30 min a day

[AlaskaAngel]

Some indications are that taking the drugs in IV form or taking large doses might be particularly problematic.

http://www.news-medical.net/?id=26929

[AlaskaAngel]

This article is quite good:

Women Advised To Speak Up And Talk To Their Dentistsfficeffice" />>>

Main Category: Dentistry News
Article Date: 26 Jun 2007 - 10:00 PDT

A woman's mouth has a lot to say, even when it's not talking. Things that alter the female body, such as prescription medications to help prevent diseases such as osteoporosis or depression, diabetes, or a vitamin deficiency, can affect a woman's oral health, according to John Svirsky, DDS, MED, who will lead a discussion titled 'Drugs I Have Known and Loved for Diseases That We Catch' during the 55th annual meeting of the Academy of General Dentistry (AGD) in San Diego, June 27 - July 1, 2007.

New Test Determines if Osteoporosis Treatment Drug May Cause Jawbone to Die.

Breast cancer patients, individuals at risk for osteoporosis, and individuals undergoing certain types of bone cancer therapies often take drugs that contain bisphosphonates. Bisphosphonates may place patients at risk for developing osteonecrosis of the jaws, which is irreversible damage in which the jaw bone rots away.

Bisphosphonates are a family of drugs administered orally or intravenously and are used to prevent and treat osteoporosis, multiple myeloma, Paget's disease (bone cancers), and bone metastasis from other cancers. These drugs can bond to bone surfaces and prevent osteoclasts (cells that breakdown bone) from doing their job. According to Dr. Svirsky, adverse affects from oral bisphosphonates will not show up until three years after the treatment starts, and after that time, the chance of developing osteonecrosis is still low. However, the incidence of developing complications while taking bisphosphonates intravenously is much higher.

During his course, Dr. Svirsky will teach dentists how this drug can affect oral health. For example, healthy bones constantly rebuild themselves but since the jawbones have rapid cell turnover, they can fail to heal properly in patients taking any of the bisphosphonate drugs. These drugs linger in the bone indefinitely and may upset the cell balance in how the jaws regenerate and remove unhealthy bone.

In addition, there is a new screening tool now available that can help patients who have been taking an oral bisphosphonate for more than three years to determine if they are at risk of developing osteonecrosis of the jaw. It is a laboratory test called the CTX (C-Telopeptide) which measures the osteoclastic activity. If the results come back above 150 pg/ml, then it is deemed safe to proceed with a tooth extraction or oral surgery.

"Patients need to tell their dentist if they take bisphosphonates or if they are going to begin bisphosphonate therapy," says Dr. Svirsky. "Osteonecrosis of the jaw due to bisphosphonate use is low in people without dental problems. If you are going to go on this therapy to treat cancer or to treat osteoporosis, you may want to get your mouth evaluated by your doctor and your dentist as well as get dental work completed before starting treatment. They can treat problematic teeth prior to the start of therapy," says Dr. Svirsky.

To help reduce the risk for osteonecrosis of the jaw and to help maintain a healthy mouth, Dr. Svirsky advises women should inform their general dentist or specialist if they are taking bisphosphonates; check and adjust removable dentures; obtain routine dental cleanings and opt for root canal therapy over extractions when possible.