bisphosphonates effect on dental healing may last years (how about bone healing??)

[Lani]

Bisphosphonates Impair Alveolar Bone Healing After Dental Surgery
Bisphosphonates can impair healing and slow turnover of alveolar bone years after the drugs have been discontinued, according to a report in the March/April issue of General Dentistry from two Texas-based researchers.

Hundreds of cases of bisphosphonate-related osteonecrosis of the jaw have been reported, the authors explain, and it has been postulated that bisphosphonates increase osteoblastic activity and decrease osteoclastic activity.

In their report, Dr. Kishore Shetty, a practicing general dentist in Austin, and Dr. J. Bouquot, an oral and maxillofacial pathologist in Houston, describe a patient who had been taking zoledronic acid chronically for metastatic cancer and who demonstrated numerous residual "ghost" sockets with lamina dura outlines that were visible radiographically.

The patient, a 73-year-old woman with a 3-year history of metastatic breast adenocarcinoma, demonstrated almost no ability to heal or remodel numerous dental extraction sites, even 2 years after cessation of bisphosphonate therapy, Drs. Shetty and Bouquot report.

Moreover, the patient had no secondary risk factors for development of these residual sockets, which did not heal despite several courses of debridement and treatment with antibiotics.

"Among patients using bisphosphonates," the investigators conclude, "residual sockets provide additional evidence of poor bone healing or very slow bone turnover."

"It is critical that dentists and oncologists are aware that this significant complication may occur spontaneously or after any dentoalveolar procedure among the population at risk," they add.

General Dentistry 2009:130-135.

[alicem]

My brother-in-law is my dentist and when I told him that I would be starting Femara soon, and that one of the side effects was bone loss, he told me "Absolutely do NOT take any of the biophosponates". He told me to find other ways to help prevent bone loss - mainly strength training and walking or running. Now he might have been referring to my specific case. I had to have a tooth extracted just one week prior to starting chemo. I needed a root canal, but there was not time to do it. They pulled the tooth and gave me a bone graft. I have been waiting until after chemo was finished to get a titanium implant. (They weren't sure how long it would take for the bone to take while I was doing the chemo.) Anyway, he told me that even one dose of an osteoporosis type of drug would do something to the bones in my gums that would prevent bone from ever growing there again. Basically he told me that I, personally, am at a great risk for this.

[donna77]

My husband is a dentist and he too is very against the long acting, once a month etc. bone medications. The daily ones are considered safer.

[Laurel]

Donna,

Why are the daily dose ones safer? I am in a clinical trial with Clondronate, a bisphosphonate that is approved in Europe and being fast tracked for approval here. To be honest, the drug concerns me on several levels, but does appear to have an effect on bone mets.

[donna77]

I asked my husband and he said bone mets were certainly a good reason to be taking these drugs. The oral form is a lower dosage so therefore a lower percentage of women have bone problems in their jaw after taking them- the dose of the medication is much higher thru an IV.

[Rich66]

Interesting albeit controversial alternative:
http://www.docguide.com/news/content...2568880078c249

[Laurel]

Thanks, Donna! Rich, I do not see anything so controversial about lasofoxifene. For a triple + gal like myself that sounds like good stuff, bone sparing and estrogen suppression with few side effects!

[Soccermom]

Soccermom


Thu Apr 16, 2009 8:40 am






http://www.usc.edu/hsc/dental/update...hNecrosis.html


FYI

"SCHOOL OF DENTISTRY CLINIC DATA LINKS ORAL BISPHOSPHONATES TO INCREASED JAW NECROSIS RISK
USCSD study is among the first to acknowledge correlation between the common medications and jawbone death.
1/01/09
By Beth Dunham
Even short-term use of common oral osteoporosis drugs may leave the jaw vulnerable to devastating necrosis, according to a new USC School of Dentistry study appearing in the January 1 Journal of the American Dental Association (JADA).
“Oral Bisphosphonate Use and the Prevalence of Osteonecrosis of the Jaw: An Institutional Inquiry” is the first large institutional study in the U.S. to investigate the relationship between oral bisphosphonate use and jaw bone death, said principal investigator Parish Sedghizadeh, assistant professor of clinical dentistry with the USC School of Dentistry.
After controlling for referral bias and other patient health factors, nine of 208 School of Dentistry patients who take or have taken Fosamax for any length of time were diagnosed with osteonecrosis of the jaw (ONJ). The study’s results are in contrast to drug makers’ prior assertions that bisphosphonate-related ONJ risk is only noticeable with intravenous use of the drugs, not oral usage, Sedghizadeh said.
“We’ve been told that the risk with oral bisphosphonates is negligible, but four percent is not negligible,” he said.
Most doctors who have prescribed bisphosphonates have not told patients about any oral health risks associated with the use of the drugs, despite even short-term usage posing a risk due to the drug’s tenacious 10-year half-life in bone tissue. Lydia Macwilliams of Los Angeles said no one told her about the risk posed by her three years of Fosamax usage until she became a patient of Sedghizadeh at the School of Dentistry.
“I was surprised,” she said. “My doctor who prescribed the Fosamax didn’t tell me about any possible problems with my teeth.”
Macwilliams was especially at risk for complications because she was to have three teeth extracted. The infection is a biofilm bacterial process, meaning that the bacteria infecting the mouth and jaw tissues reside within a slimy matrix that protects the bacteria from many conventional antibiotic treatments, and bisphosphonate use may make the infection more aggressive in adhering to the jaw, Sedghizadeh said. The danger is especially pronounced with procedures that directly expose the jaw bone, such as tooth extractions and other oral surgery.
After her extractions, two of the three extraction sites had difficulty healing due to infection, Macwilliams said. Luckily, with treatment as well as the rigorous oral hygiene regimen that USC dentists developed especially for patients with a history of bisphosphonate usage, the remaining sites slowly but fully healed.
“It took about a year to heal,” she said, “but it’s doing just fine now.”
Sedghizadeh hopes to have other researchers confirm his findings and thus encourage more doctors and dentists to talk with patients about the oral health risks associated with the widely used drugs. The results confirm the suspicions of many in the oral health field, he said.
“Here at the School of Dentistry, we’re getting two or three new patients a week that have bisphosphonate-related ONJ,” he said, “and I know we’re not the only ones seeing it.”
__________________... Soccermom

[Rich66]

In terms of controversy, was referring to the FDA's halting endorsement due to safety concerns. In theory, it's a win-win on bone loss and endocrine fronts.

[Believe51]

With every choice we make on this journey there is a reaction......

Please note that if Ed did not do his Zometa monthly, he would not have the bone repair he has had. He has both lytic and blastic lesions and severe bone mets, He must repair his bones after killing the cancer and some of us do not stand a chance without this drug. His spine is collapsing and his neck is crumbling, without Zometa he would be paralyzed right now.

Given our individual situations some of us must do things that are bad for us because something worse will happen.

Remember to that these statics for this to happen are rare unless we are gathering newer information and that changes.

Although this side effect is extemely aweful, some of us do not have a choice in the matter. We never say never. Keep an open mind just in case you would ever need this....please.>>Believe51

[Soccermom]

Marie,
I most emphatically agree...we must do what we must do. Sadly none of our choices are "good" ones. I would never infer someone shouldnt "do" Zometa,I just like educating folks about possible side effects.
I am very happy that Zometa has helped Ed so much!!!

Hugs,Marcia

[Believe51]

Marcia, this is what makes this group so vital to all of its family members. Our experiences, knowledge and individual journeys allow us to gather for own own journeys. By posting information and research here we have help in understanding the risks and the importance of a variety of issues. We then can make the best choice for the problem at hand. I want to know that when that time comes we did whatever we could in the best manner possible. Hugs right back at 'cha. Love>>Believe51

[harrie]

As with anything, one needs to weigh the risks and benefits. With biophosphonates, ONJ is not a sure thing, but it is a risk factor, higher with IV then the oral.
I am very curious to know if the montly oral biophosphonate creates a higher risk factor then the weekly dosage or is the risk factor the same.
The research article I read which came from USC did not address this particular situation.

[Rich66]

"As with anything, one needs to weigh the risks and benefits."

I just received a copy of a study where apatient had multiple non-skeletal metsatases significantly reduced by Zoledronate monotherapy. Would post the pdf but a little too large and can't copy/paste the text