Osteoporosis Drugs May Cause Jaw Fractures   Frank Barnhill M.D.
 

In an earlier article we discussed the use of drugs called biphosphonates to reduce or reverse bone loss in osteoporosis and their effects on bone and your heart.

Recent literature reports these drugs may also be associated with an increased risk of bone death in a particular part of the jaw (mandible more often than maxilla) and fracture occurring as a result of weakening of the jaw in that area. The defect is usually found at time of a regular dental visit or prior to oral surgery as some patients have no symptoms of the disorder. Most affected persons will complain of loose teeth, pain in the jaw, swollen gums or foul odors of infection.

Biphosphonate-related osteonecrosis of the jaw (BRONJ) was initially thought to occur only when patients received these bone drugs by the intravenous route using zoledronic acid and pamidronate. However, further studies have indicated the same problem may occur even when alendronate, ibandronate, and risedronate are taken by mouth for osteoporosis treatment.

Treatment for BRONJ involves removal of damaged bone, control of any infections, and pain management. Of course, the culprit drug must be stopped.

It appears the longer you take the drug and the higher the dose taken, the more likely you are to develop BRONJ. Therefore you should weigh your options prior to starting biphosphonate therapy:

Key Note: It does little good to stop these medications for three weeks, three months or even a year prior to having dental work or oral surgery, as this class of drugs can remain active in your body for years after taking them.

The reason biphosphonates cause osteonecrosis of the jaw is still unclear and even though the association appears strong much more research is needed to further define the disorder.

Dr. Frank

Reference: Core content review Of Family Medicine, Vol. 39 April 2008

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