Any concerns with Zometa and Osteonecrosis? My dentist scared me.

Vic · 01-22-2009, 09:51 PM

I had my teeth cleaned today and mentioned to the dentist that I was having a bone density test, because my doctor wanted me to take twice-yearly Zometa infusions. He was very wary of this when I told him it was based on a small study that examined the benefits of the drug to prevent bone metastases and proceeded to tell me about a USC study (he gave me the oral surgeon's name) and went into details about positive and negative-charged atoms and how it binds to the bone. He went on further to say that the old-time bisphosphonates didn't have the osteonecrosis problem due to the addition of this atom. It all got pretty technical, but he showed me a laptop photo and it was a horrible image.

I told him I didn't think it was as much of a problem if you weren't on chemo, and he said that infusions of bisphosphonates were the problem, and not the pill form.

Secondly, when I saw my gyn., she mentioned a drug called Fortera (or something like that; I'll put a call into her next week) that is bone-building, like Zometa, but doesn't have the osteonecrosis problem. She started explaining the osteoblasts and osteoclasts.

Apologies for not having all the information, but do any of you have concerns about this and what, if anything, have your doctors and dentists said about Zometa and bone-building drugs?

Thanks,

Vicki

Kim in DC · 01-22-2009, 10:06 PM

The majority of ONJ cases occur when people are taking another type of chemo along with Zometa and then have dental surgery. There have been some cases Fosamax and Actonel as well.

The drug your GYN is talking about is Forteo. It does stop bone loss but it is a totally different class of drugs. It works differently than bisphosphonates, you have to inject it yourself, and you can only take it for 2 years. Your Onc is giving you Zometa to prevent cancer and Forteo acts a totally different way. There are no studies that suggest it's efficacy against cancer.

Kim

Susan · 01-23-2009, 06:23 AM

Hi: I'm a dental hygienist, and I know at our office, when someone is on any bisphosphorates (which now days, effects a large number of patients), the only issue we have is for extractions. We always refer any patients on those drugs to an oral surgeon, and they will do a blood/urine test to see if they would be a candiate for an extraction. We actually only have one surgeon in the our area that will be willing to do surgery w/ the test, so just hope we don't need any teeth pulled! But as a far the bisphosphorates affecting having your teeth cleaned, routine fillings/crowns, that is not problem. But make sure you let your dentist know that you are on any zometa- like drugs. The drug Forteo is a different type of drug than the zometa.

RobinP · 01-23-2009, 06:50 AM

HI Vic,

Just wanted to throw this out there for you. I heard a webcast by the famous Dr. Larry Norton at Mem. Sloan Kettering Ca. Ctr. and he said that he does not advocate biphosphonates for early stage bc and that a new and better drug will soon be on the market to prevent bone mets and build bone mass. Copied my post about that and the link below to Larry Norton's talk:
http://74.125.45.132/search?q=cache:...lnk&cd=4&gl=us
PS. I agree that the oral biphosphonates are a lot safer than the infusions. You could always get a second doc opinion on this.

FYI Here is the link to the new bone drug
http://www.communityoncology.net/jou...es/0506291.pdf

http://www.oncolink.com/resources/ar...th=01&id=15938

Vic · 01-26-2009, 11:09 AM

This is just what I was looking for, and I really appreciate your input on Zometa and dental health.

Thanks, Kim, for giving me the correct name of the other drug (Forteo) and its differences. Susan, knowing you're a dental hygienist, is very reassuing and your experience in the field will really help me make my decision about Zometa.

Robin, I had no idea another drug was in the works. These links you provided will help me do my research and I'll check them out. I just hope, if they prove to be safer than Zometa, that they will be offered soon. I'm thinking I would like to start the Zometa infusions this spring. (Becky, I know you've been on Zometa and will you stop your infusions after three years? Or, do you continue indefinitely due to your osteopenia?)

Your quick feedback means so much to me and really shows why this website is such a wonderful, caring and helpful place to be.

See you online,

Vicki

Rich66 · 01-26-2009, 11:45 AM

A vague but possibly helpful article:

Reduction of osteonecrosis of the jaw (ONJ) after implementation of preventive measures in patients with multiple myeloma treated with zoledronic acid

M. A. Dimopoulos1,*, E. Kastritis1, C. Bamia2, I. Melakopoulos3, D. Gika1, M. Roussou1, M. Migkou1, E. Eleftherakis-Papaiakovou1, D. Christoulas1, E. Terpos4 and A. Bamias1 1 Department of Clinical Therapeutics
2 Department of Hygiene and Epidemiology, Medical School, University of Athens
3 Department of Maxillofascial Surgery, H. Dunant Hospital
4 Department of Biomedical Research, 251 General Air Force Hospital, Athens, Greece
* Correspondence to: Dr M. A. Dimopoulos, 227 Kifissias Avenue, Kifissia, Athens 145 61, Greece. Tel: +30-210-3381541; Fax: +30-210-3381511; E-mail: mdimop@med.uoa.gr
Background: Osteonecrosis of the jaw (ONJ) is a well-described complication of bisphosphonates use in patients with multiple myeloma (MM). We investigated whether the occurrence of ONJ decreased after the implementation of preventive measures in 128 patients with MM who received zoledronic acid.
Patients and methods: Patients with MM who received zoledronic acid were included in this analysis. Patients with a previous use of other bisphosphonates were excluded; patients were stratified into group A (n = 38) and group B (n = 90) if treatment was started before or after the implementation of preventive measures.
Results: One hundred and twenty-eight patients were included in this analysis. Sixteen patients (12.5%) developed ONJ—group A: 8 (26.3%), group B: 2 (6.7%) (P = 0.002). The incidence rate (IR) was 0.671/100 person-months for group A and 0.230/100 person-months for group B [IR ratio 2.92, P = 0.029, 95% confidence interval 1.06–8.03]. No patient in group B developed stage III ONJ.
Conclusion: In conclusion, the risk of developing ONJ after treatment of zoledronic acid is reduced (but not deleted) by the implementation of preventive measures.
Key words: multiple myeloma, osteonecrosis, preventive measures, zoledronic acid
Received for publication February 6, 2008. Revision received June 13, 2008. Accepted for publication July 15, 2008.

StephN · 01-26-2009, 12:32 PM

Hi Vickie -
What to do with our bodies gets to be full of burning questions, huh?

Regarding your question, did you see the following post from Lani:
http://her2support.org/vbulletin/showthread.php?t=37687

This is a German study of metastatic breast cancer patients who were taking biphosphanates. Of the surviving cohort there was about a 5% incidence of ONJ with Zometa over 6 years, but again these patients were on other chemos and some had bone mets.

Actually, I think your plan of beginning with Zometa and then moving to another drug when it is available is not bad. Especially since you are healthy now and most likely not in any immenent need of tooth extraction.

(Getting my teeth cleaned again tomorrow!)

Vic · 01-26-2009, 08:51 PM

Nice to hear from you, Steph, and I love your pic and your wonderful quote. Excellent and I love Thoreau.

Yes, these decisions we have to make based on what's presented to us at our office visits does make life interesting, doesn't it? I appreciate you pasting in Lani's post, too, as she always provides such good material for us to use and consider.

Smile. Your teeth will be sparkling tomorrow (and don't forget to floss).

XO,

Vicki

suzan w · 01-27-2009, 04:59 PM

I have been doing daily injections of Forteo for a year. One more year to go, then Zometa infusions. I was not aware of the other drug (Lani's post?) but will ask my doc about it. I did talk to my dentist about osteonecrosis before starting Forteo. It seems like no one really has any answers as we are the ones taking these drugs now, then, based on what happens to us....they will come up with statistics!

dchips1 · 02-02-2009, 11:01 PM

I had 2 root canals while on Zometa with no problem, by an endodontist,,,it was the dental "tech" who made the original wound in my lower jaw, with a bite wing xray, that I told her it hurt. that has cost me a lot of pain, money and soon a chunk of my mandible.

Get your teeth taken care of but BE YOUR OWN ADVOCATE They must exercise extreme caution with tools, x-rays even thier hands when dealing with your mouth. My peri even numbs up the tooth in a different location.

Good Luck