Bisphosphonates and osteonecrosis of the jaw
The association of treatment with bisphosphonates and osteonecrosis of the jaw. There have been several case reports in the dental and medical literature recently where patients on bisphosphonate therapy--usually I.V. therapy for cancer metastasis--have developed osteonecrosis of the maxilla or mandible (infection of the upper or lower jaw bones). This can be a very difficult condition to diagnose and treat that may require long-term antibiotic therapy along with hyperbaric oxygen, and even that is no guarantee of successful resolution of the problem. Here is a Website with specifics on signs and symptoms of osteonecrosis of the jaws. It appears that the vast majority of cases that have been reported so far have been in cancer patients treated with I.V. bisphosphonates, but there are a few people with osteoporosis taking oral bisphosphonates such as Fosamax or Actonel that also have developed the problem. This means that patients and dentists need to be aware that jaw pain, and other signs and symptoms of osteonecrosis, in people on bisphosphonate therapy, should raise a red flag. If the pain doesn't appear to follow "normal rules," this would be especially suggestive that osteonecrosis might be involved. Another tip off could be a history of recent dental treatment such as tooth extraction, dental infection, or trauma to the area. There have been reported cases of osteonecrosis, however, where there was no obvious cause of the osteonecrosis.
Editor's comments: At this time, osteonecrosis of the jaws doesn't appear to be a significant problem for those of us taking bisphosphonate therapy for osteoporosis who are otherwise healthy. However, if you are taking bisphosphonates and feel you have a compromised immune system due to medications you are taking or illness, I would recommend that you be cautious as regards elective dental surgical procedures. The odds of developing osteonecrosis appear to be very slim, but there is no reason to take a chance either. When your immune system is back to normal, then you can have the elective surgical dental procedure done.
List of PubMed articles concerning bisphosphonates and osteonecrosis of the jaw:
Migliorati CA, Schubert MM, Peterson DE, Seneda
LM.
Bisphosphonate-associated osteonecrosis of mandibular and
maxillary
bone.
Cancer. 2005 May 31; [Epub ahead of
print]
PMID: 15929121
Schirmer I, Peters H, Reichart PA, Durkop
H.
[Bisphosphonates and osteonecrosis of the jaw.]
Mund
Kiefer Gesichtschir. 2005 May 26; [Epub ahead of print] German.
PMID:
15918066
Hellstein JW, Marek CL.
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J
Oral Maxillofac Surg. 2005 May;63(5):682-9. Review.
PMID: 15883944
Melo MD, Obeid G.
Osteonecrosis of the maxilla in a
patient with a history of
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J Can Dent
Assoc. 2005 Feb;71(2):111-3.
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Robinson NA, Yeo JF.
Bisphosphonates--a word of
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PMID: 15389307
Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff
SL.
Osteonecrosis of the jaws associated with the use of
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review of 63 cases.
J Oral Maxillofac Surg.
2004 May;62(5):527-34.
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