Questions about Fosamax, Bisphosphonates and Osteonecrosis of the Jaw

Thank you for the excellent review of the Bisphosphonate and jaw osteonecrosis issue. As a practicing dentist with patients who have been taking oral bisphosphonates and now require oral surgery I am anxiously awaiting more definite guidelines as to how or wether to proceed with needed treatment - for example, a 58 year old female with a 4 year Fosamax (70mg QD)history (per osteoporosis risk) who has a grossly decayed tooth with a radiographic abscess, which fortunately is now asymptomatic, but really should be removed soon. Our oral surgeon has recommended holding off until possibly the "CTX" test becomes available to us in order to check the patient's bisphosphonate blood level. Also, is there any evidence that if a patient like this came off her bisphosphonate for a period of time (2 or 3 months?) that her osteonecrosis risk would be reduced to an acceptable level? I just hope the tooth (and its bacteria) continues to "cooperate!" Thank you for your guidance. DW

In JADA, August 2006 there are published guidelines for dental management of patients taking oral bisphosphonates. The risk reported for developing Bisphosphonate-associated osteonecrosis of the jaws in patients taking alendronate was .7/100,000 person/year which is a pretty small risk. As an oral surgeon in private practice I routinely extract teeth, place implants etc...etc in patients taking oral bisphosphonates, I have found the recent published guidelines helpful in my treatment of these patients. I believe your patient would do fine to have her tooth extracted with out any additional testing. If your patient was receiving pamidronate or zoledronic acid the ctx test may be useful. take care Dr. Jeff Lee

I understand that osteoporosis is designated at a reading of -2.5 or lower.  I also understand that 'severe osteoporosis' is designated at -2.5 or more plus a fracture.

 

My question is:  My readings for spine/hip are -4.1.  How common is that? How unusual?  How low do readings tend to go? 

 

Age 60, newly diagnosed, white female. History of malabsorption, petite.

 

Thank you.

osteonecrosis?  she yanked it out of the roof of my mouth once, sent it to a lab to see if it was cancer; it was not.  then i read your article which described the lesion of ONJ as:

 

"...a lesion with areas of esposed yello-white hard bone with smooth or ragged borders."

 

this is EXACTLY how both my PCP (who was clueless what it was) and the ENT described it....also, my dentisit took a picture and showed it to me on the monitor.....he didn't know what it was either, but it looked like your description to me.........

 

my PCP said NO case of ONJ has been connected to IV Boniva, and if that IS what this lesion is, it should be reported to the CDC and FDA.....sooooo, since my ENT doesn't know what to do, do you have some advice?

 

thanks!  kathie (wyldrose@aol.com)