Re: Bisphosphonates

I understand what you are saying. But for me it does not make sense to
give something to patients thats treats one problem while creating
another. It's different if we had no proof or knows cases of adverse
effects, but in the case of bisphosphonates we do. I suppose patients
undergoing cancer treatment an are fighting for their life, what's a
risk of jaw necrosis to them?? I'm sure it is further from their mind.
Heck the chemo alone is toxifying to their system. However there are
many patients right now that are taking these meds for prophylactic
reasons not knowing the risks. I certainly think we need to find
alternative treatment for cancer patients and those taking the meds for
prevention with the emphasis and urgency on the former. Apparently this
is how we treat people in this part of the world we exchange one
problem for another and get them hooked on pills and surgery as the
answer to everything. (will that be paper or plastic...brand name or
generic)

Steven Bornfeld wrote:
Alexander Vasserman DDS wrote:
well that's fine for patients with current dental problems but what
about if there is future dental trauma due to injury? What then???


Alex--

Whatever I say today may be worthless tomorrow. Cox-2 inhibitors were
the biggest thing since sliced bread; now they ain't. We always have to
make the best decisions we can based on the available evidence. 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.

Steve


Mark & Steven Bornfeld wrote:
Alexander Vasserman DDS wrote:

I would think it would be prudent for patients who are being put on
these medications to at the very least take cake of all their dental
problem and be clear of any dental complicaions as a result of dental
treatment for a period of at the very least 2 years before initiating
these meds. Because once they start these meds and another dental
problem arises they automatically become part of the statistics.

Maybe. But at the very least, oncologists and urologists who wish to
put their patients on IV bisphosphonates should inform their patients of
the very real risk and find out if they are current with their dental care.
Full disclosure: my dad has stage IV prostate ca with bony metastasis.
His urologist decided to put him on Zometa, and not a word about risk
of dental treatment. I told him I was a dentist, and whether it might
be possible to delay starting the Zometa while I dragged my dad into the
office for the first time in a couple of years. My dad needed two
extractions and one root canal. Naturally I was not happy, and resisted
the urge to tapdance on the urologist's head. I asked if he was aware
of the problem, and he said he'd "never seen a case" of ONJ.
Well, hopefully I edjakated him.

Steve


Hummy wrote:

But ONJ in these cases is not rare, and it is a

condition with a significant morbidity itself, an no--that's
ZERO--effective treatment at this time.

Steve
Hi Steve,
I appreciate your response. Yes, I agree that ONJ has a significant
morbidity with no cure at this time. We surely don't have the full
picture yet. Still, I try to stay current with women's health issues.
Just so you know from where I get my information, here is what I am
being told in the current issue of my Harvard Women's Health
Newsletter:

Since we last wrote about this problem, more cases of osteonecrosis
have been reported. Most have occurred among cancer patients taking
intravenous bisphosphonates, but a handful have involved otherwise
healthy women taking oral forms of these drugs for osteoporosis
prevention or treatment...
...Compared to the millions of women taking bisphosphonates, the number
of osteonecrosis cases is still negligible. The American Dental
Association estimates the prevalence to be only about 0.7 cases per
100,000 person years. That translates to 7 cases per year for every one
million people taking oral bisphosphonates. The risk is mostly among
cancer patients taking zoledronate or pamidronate. To further
investigate the extent of the problem among otherwise healthy women
taking bisphosphonates, researchers at the Harvard School of Dental
Medicine are examining medical insurance claims for jaw surgery. Also,
the National Institute of Dental Research plans to study the
development of the condition in bisphosphonate-takers...

Hummy


--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001


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