Bisphosphonate Osteonecrosis
- What are Bisphosphonates?
- What is Bisphosphonate Osteonecrosis?
- I have osteoporosis and I am using Bisphosphonates. Am I at risk for Osteonecrosis of my jaw bones?
- How does Dr. Ram evaluate me?
- What are the available treatments?
- Should I stop taking my bisphosphonate medication?
What are Bisphosphonates?
Bisphosphonates are a class of drugs that are used to prevent bone loss in patients with:
- Osteoporosis (the loss of bone density often seen in postmenopausal females)
- Hypercalcemia of Malignancy (Increased calcium in the blood from bone breakdown) and
- Metastatic disease to bone (Cancer spreading to bone tissue).
Some of these drugs can be taken by mouth, while others must be given intravenously at a hospital or clinic. Examples include drugs such as Fosamax™, Actonel™, Zometa™, and Boniva™.
What is Bisphosphonate Osteonecrosis?
Bisphosphonate osteonecrosis is a rare side effect of using bisphosphonate medications. The hallmarks of this condition are gum wounds that heal very slowly or do not heal at all for six weeks or more after a procedure and exposed bone. Some patients report that this begins with a feeling of “roughness” on the gum tissue. If these open wounds become infected, you may see pus or swelling in the adjacent gum tissue. Many times, this condition is painless in the beginning, and patients only experience pain after the exposed bone becomes infected. If this infection lasts long enough, there may even be numbness, especially in the lower jaw.
Bisphosphonate osteonecrosis of the right upper jaw bone
I have osteoporosis and I am using Bisphosphonates. Am I at risk for Osteonecrosis of my jaw bones?
Yes. However, most reported cases occur after oral trauma (tooth extraction or oral surgical procedure). The risk is low (1-4%) if you are taking oral bisphosphonates and higher (28%) if you are receiving intravenous (iv) bisphosphonates. Other risk factors include tobacco use, treatment with corticosteroids and diabetes.
How does Dr. Ram evaluate me?
Dr. Ram, the specialist in this area, will listen to your history and perform a thorough clinical examination and review your jaw x-rays and provide a treatment plan. Dr. Ram will work closely with your physician, oncologist, ENT surgeon or Oral surgeon to manage your osteonecrosis problem.
What are the available treatments?
Unfortunately, at this time most reported treatments are slow to resolve osteonecrosis of the jaw, so the best treatment is prevention. Current treatment methods that are used include antiseptic rinses, systemic antibiotics, and cleaning/removal of dead bone from the affected area. If your dentist diagnoses the condition he or she may send you to a specialist in oral medicine or oral surgery to evaluate the best possible therapy. Generally, therapy focuses on controlling pain and preventing infection so that the body can heal properly.
Should I stop taking my bisphosphonate medication?
Not without the advice or instruction by your physician. These drugs have been shown to be stored within the bones and slowly released over time. It is believed that, even when not taking the medications, the drugs can persist for decades in bone. There is no evidence that stopping the medication will reduce the risk of developing osteonecrosis of the jaw. The only reason to stop taking your medication is because your physician specifically instructs you to do so.