Be Aware if You Take Bisphosphonates

Scientists are investigating a possible connection between the death of bone tissue (osteonecrosis) of the jaw and medications known as bisphosphonates. Bisphosphonates are commonly used to treat and prevent osteoporosis and to treat bone pain in cancer patients. Thus far, no clear cause-and-effect relationship has been established, but there are good reasons to suspect that bisphosphonates play a role.

Reports of osteonecrosis in people taking bisphosphonates first began surfacing in 2003. The vast majority of cases—about 90 percent—have involved cancer patients receiving high doses of bisphosphonates such as pamidronate (Aredia), clodronate (Bonefos), and zoledronic acid (Zometa).

But this side effect also has been reported, although with far lower frequency, in patients taking oral bisphosphonate medicines—such as alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva)—which are commonly prescribed for osteoporosis.

How common is this problem? According to studies cited by the American Dental Association (ADA), about 20 percent of patients taking intravenous bisphosphonates for cancer therapy develop osteonecrosis. For people taking these drugs orally, the risk hovers between zero and 0.04 percent.

In December 2008, the American Dental Association issued an advisory statement reiterating the group’s 2006 position that individuals taking oral bisphosphonates are at very low risk for osteonecrosis of the jaw. They went on to state that for the millions of people taking these drugs, their value in preventing osteoporosis-related fractures, and the potentially life-threatening complications that can result, far outweigh the relatively minute risk of jawbone destruction.

But the question of who may be at risk and under what circumstances has not yet been put to rest. In January 2009, a group of researchers at the University of Southern California School of Dentistry conducted a small study in which they analyzed the records of 208 patients in their clinic who were taking alendronate. They discovered that nine of these patients, or approximately 4 percent, had developed osteonecrosis after a tooth extraction or other dental injury—a rate higher than had been reported previously.

Before you start taking a bisphosphonate, it’s a good idea to have a dental exam and complete any necessary extractions or implants.

If you are already taking a bisphosphonate, tell your dentist so she or he can consider it in planning your treatment. Also, be diligent about maintaining good oral hygiene and seeing your dentist for regular exams. Finally, be aware of the symptoms of osteonecrosis, which include pain, swelling, or infection of the gums or jaw; gums that aren’t healing; loose teeth; and numbness in the jaw. Contact your dentist at the earliest sign of trouble.

Source: Dental Health for Adults: A Guide to Protecting Your Teeth and Gums. Copyright © by Harvard University. All rights reserved.