Re: Bisphosphonates

Alexander Vasserman DDS wrote:
It is a big problem. Basically patients that have been taking
bisphosphonates are at risk of jaw necrosis and there is not much that
can be done for them. The treatment for jaw necrosis involves major
surgery prosthetics and disfigurement as a result and there is no way
to prevent this. Anything from a simple extraction or root canal or
dental implant can cause this in the wrong patient.
We are told to tell patients to discuss these risks vs benefits with
their physician who is prescribing these meds. In my opinion these meds
are too dangerious and should not be precribed. I can forsee a class
action starting against these companies that are releasing these pills.
We will be seeing more cases of jaw necrosis as a result. I also
believe the FDA is at fault for giving clearance to these pills. The
warning label is enough to discourage anyone from taking these meds.
Obviously osteoporosis patients benefit from these drugs but should
they develop a tooth ache, decay needing a root canal, an injury to
their teeth and jaw requiring cosmetic repair, they are out of luck and
may have been in a better situation if they did not take these pills.

It is always difficult to do a seat-of-the-pants risk/benefit analysis when the risk takes years to fully evaluate. Surely fractured hips in the elderly are a major health risk. The concensus is that this is still a small risk with oral bisphosphonates. We need to keep an eye on the statistics though.
I asked a urologist who put a relative of mine on IV Zometa whether he'd seen cases of ONJ. Of course he did not--who even knows how often the prescribing urologist/oncologist etc. will see the results of their medications?
By the same token, I cannot in good conscience scare patients off bisphosphonates when I cannot evaluate or see the morbitity associated with osteoporosis. This is a difficult issue, and we all do the best we can. And then the lawyers come in and make those fine judgements for us.

Steve



Steven Bornfeld wrote:
George Maxfield wrote:
Anyone have any horror stories about the ubiquitous oral bisphosphonates
(Boniva, Fosamax)causing osteonecrosis of the jaw as a result of perio
surg, implants, or extraction?

There are scattered reports, and they're bound to become more numerous
over time. Still, considering the number of people on these drugs the
numbers of ONJ that can be linked to oral bisphosphonates is small.
This of course is not true of injectible bisphosphonates. However,
since most patients receiving these drugs have significant illness being
treated and the risk of pathologic fracture as a result is high (and the
morbidity associated with these pathologic fractures is significant) the
relatively higher risks associated with the injectibles is justifiable.

Steve

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Relevant Pages

  • Re: Bisphosphonates
    ... Basically patients that have been taking ... The treatment for jaw necrosis involves major ... numbers of ONJ that can be linked to oral bisphosphonates is small. ... treated and the risk of pathologic fracture as a result is high (and the ...
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    ... (mandibular advancement to protect me from developing jaw joint pain) ... I was not willing to take the risk about such a new drug. ... give something to patients thats treats one problem while creating ... but in the case of bisphosphonates we do. ...
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    ... I have not heard anyone actually die from a broken hip but maybe this ... I would also suspect that if bisphosphonates cause necrosis of the jaw, ... risks of adverse effects and jaw necrosis are. ... when the risk takes years to fully evaluate. ...
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  • Re: Bisphosphonates
    ... Alexander Vasserman DDS wrote: ... Most important is that we don't operate in a professional vacuum--we know why the patients are being medicated; other professionals know our concerns, and we try to work out the best overall assessment of risk and benefit to the patient--and hopefully bring the patient into the decision-making process--since whatever clinical decisions we make develop the risks they must accept. ... intravenous bisphosphonates, but a handful have involved otherwise ...
    (sci.med.dentistry)
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    ... give something to patients thats treats one problem while creating ... but in the case of bisphosphonates we do. ... alternative treatment for cancer patients and those taking the meds for ... and we try to work out the best overall assessment of risk and benefit ...
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