Re: Bisphosphonates

I admit to a person interest in this topic. In fact, I posted about
this very topic back in March of this year.

I lost both of my jaw joints (TMJ) to osteonecrosis which was one of
many unfortunate complications resulting from orthognathic surgery
(mandibular advancement to protect me from developing jaw joint pain) in
1983. People with a long history in smd are likely familiar with "my
story".

Back in 2000, I underwent dental care under general anesthesia in the OR
of UCLA. (This was necessary because of my very limited jaw opening.)
The pre-admission workup revealed that I had significant osteoporosis
and the internal medicine doctor was more than eager to immediately
place me on both hormone therapy *and* Fosamax. I was concerned about
what impact the osteoporosis might have had upon the jaw bone because
one of the difficulties of the dental surgery and dental restorative
work was the fact that overextending the opening of my jaw under general
anesthesia could result in the two artificial jaw joints (TMJ) literally
popping off the bone; fracturing the jaw and destroying my
prosthetic-situation.

Anyway, long story short, I said "no" to the Fosamax simply because at
that time, there was only seven years experience with the drug. It was
going to be prescribed as a drug I would take for the rest of my life.
I was not willing to take the risk about such a new drug. On the other
hand, I was willing to accept that I had a "high risk of fracture"
according to my bone density studies (and I still do). On the balance
scale, there was "the risk of the unknown" on both sides of the scale.
I decided to stick with not rocking the boat. And! Am I ever glad that
I made the decision not to take that drug.

I can't imagine today, a good six years after that event, why there
hasn't been more concern about this among people who have serious
conditions related to "the surgical TMJ".

Should I one day find myself needing this family of drugs for the
treatment of a cancer, I am very willing to admit that I would not be
able to make a decision to be aggressive towards the cancer. The
thought of more osteonecrosis of the jaw is absolutely terrifying to me.

The one thing I see at this point, is another unfortunate chapter in the
book titled, "The TMJ Iatroepidemic".

Webby





In article <1165217442.158371.232620@xxxxxxxxxxxxxxxxxxxxxxxxxxxx>,
"Alexander Vasserman DDS" <purple543210@xxxxxxxx> wrote:

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

.

Relevant Pages

  • 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)
  • Re: Interesting NICO information!
    ... bone disease called osteonecrosis of the jaw. ... ONJ is a condition in which the bone tissue in the jaw fails to heal ... a cluster of cancer patients with necrotic lesions in the jaw -- a condition ... Bisphosphonates are commonly used in tablet form to prevent and treat ...
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  • 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 ...
    (sci.med.dentistry)
  • Re: Bisphosphonates
    ... The treatment for jaw necrosis involves major ... Obviously osteoporosis patients benefit from these drugs but should ... when the risk takes years to fully evaluate. ... The concensus is that this is still a small risk with oral bisphosphonates. ...
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  • Re: ONJ in USA Today
    ... > bone death of the jaw in the Journal of Oral and Maxillofacial Surgery. ... > severe with oral bisphosphonates as it is with the IV drugs, ... Patients who have been receiving IV bisphosphonates should avoid ... > suggests that osteonecrosis of the jaw is a risk of all ...
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