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BISPHOSPHONATES ASSOCIATED WITH OSTEONECROSIS

The use of bisphosphonates (Zomeda, Aredia, Fosamax, Didronel, Actonel and Boniva) has been associated with spontaneous necrosis (death) of bone in the jaws or following minor oral surgery. These drugs are used either for the treatment and prevention of osteoporosis or for the treatment of the lowered bone calcium (hypocalcemia) in the malignancy and bone metastasis of solid tumors. These drugs are effective in osteoporosis because of their ability to induce the cells that help our bones to be constantly disolved and renewed (called "osteoclasts") to self-destruct. They can no longer do their part in leaching the calcium out of bones (a normal physiological process in all of us) while those cells laying down new calcium (called "osteoblasts") go right on doing their thing resulting in a stronger skeletal system. However, the denser the bone the less available blood circulation inside of the bone and the more difficult is the body's ability to deliver white and red blood cells to the structural matrix of the bone. This decreased nourishment can result in "dead" zones especially if there is an existing infection as a result of a dental problem.

Although millions of patients have taken bisphosphonates, only a few hundred have appeared wiith osteonecroses of the jaws. Most of those have been associated with the high dosages of the medication given to oncology patients. The most severe cases appear to occur in patients with metastatic cancer and multiple myeloma. Smoking and diabetes may also make the problem of osteonecrosis, if it occurs, more severe. (It has recently been discovered that Boniva appears to be just as effective in treating breast cancer as tamoxifen with fewer side effects so we may be seeing more bisphosphonates in the future).

Although there is no scientifically proven direct causation of osteonecrosis by these drugs, there appears to be a direct relationship with their use and the development of this disorder. In any event, chronic dental infections should be eliminated prior to chemotherapy and bisphosphonate use in cancer patients!
posted by Steve at 6:38 PM