Osteoporosis Treatments and Osteonecrosis of the Jaw

Several reports have been published recently on the possible connection between drugs commonly prescribed for the treatment of osteoporosis (bisphosphonates) and a condition called osteonecrosis of the jaw. This is a condition in which the bone in the jaw and supporting the teeth can be damaged or lost. Drugs that fall into this category include those sold under the brand names Aredia, Zometa, Fosamax, Actonel, Boniva, Didronel and Skelid. Aredia and Zometa are most often given intravenously for treatment of bone and other cancers, while the other medications are taken orally for the treatment of Paget disease and osteoporosis. Most reported cases of bisphosphonate-related osteonecrosis of the jaw (BON) have been linked to the intravenous drugs used for cancer treatment. Reports of BON associated with the oral drugs have been very rare with an estimated incidence of less than 0.7 cases per 100,000 person-years of drug exposure. The risk for developing BON is very low when compared to the significant benefit these drugs provide in treating diseases like osteoporosis. The medical and dental communities have studied this risk and have made recommendations to further minimize your risk of developing BON if you are taking any of these drugs.

Several risk factors have been identified that can increase or decrease your risk of developing BON¹
.

• The first risk factor is the specific drug type and its length of use. The intravenous drugs used for cancer treatment have a higher risk and longer usage period of any of the drugs that increase the risk for developing BON¹.
• The second risk factor is dental surgery involving the jaw bone. Dental procedures, such as tooth extractions, implant placement, and periodontal surgery involving the bone, increase the risk for developing BON¹.
• The final risk factor is poor oral health. Conditions such as periodontal disease or dental infections involving the bone are associated with a higher risk for developing BON¹.

There are several things you and your health care providers can do to prevent or reduce your risk for developing BON¹.

• If your physician has recommended you begin taking a bisphosphonate drug, you should have a thorough dental examination prior to beginning the drug therapy. Any invasive treatment, such as tooth extractions, periodontal surgery, or implant placement, should be completed prior to beginning the drug therapy.
• If you are currently taking bisphosphonates it is important to maintain good oral health. Continue your regular dental checkups so that potential problems are detected early and the need for more invasive treatment is prevented.
• If you have partial or full dentures, make sure they fit well to prevent sores from developing in your mouth.
• If you are currently taking or planning to take bisphosphonates, it is very important that you inform your dentist so that informed and appropriate treatment decisions can be made. Your dentist can discuss your treatment needs with you and your physician to minimize your risk for developing BON.

While the risk of developing bisphosphonate-related osteonecrosis is very small, these simple measures can reduce it even further. If you should require dental treatment that increases your risk, your dentist and physician can work together to minimize this risk.

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1. American Dental Association Council on Scientific Affairs. Dental management of patients receiving oral bisphosphonates therapy: Expert panel recommendations. J Am Dent Assoc. 2006 Aug;137(8):1144-50.

2. Ruggiero S, et al. Practical guidelines for the prevention, diagnosis, and treatment of osteonecrosis of the jaw in patients with cancer. J Oncol Prac. Jan;2(1):7-14.