Recently, many patients have come to me, concerned regarding the risk of osteonecrosis of the jaw secondary to Fosamax. As many rheumatoid arthritis patients suffer also from osteoporosis, it is reasonable to discuss this issue which has been appearing in newspapers across the country.
Osteonecrosis refers to bone death; the bone involved cannot repair itself because it lacks the normal blood supply. There have been hundreds of cases reported of osteonecrosis of the jaw in patients taking bisphosphonate drugs, of which Fosamax is one. While many of the cases occurred in cancer patients on intravenous bisphosphonates, there have been reports of osteonecrosis in women who have had teeth pulled and are also taking Fosamax.
Osteonecrosis of the jaw can lead to infection and destruction of the jawbone, leading in turn to disfigurement of the face. It is for this reason that patients on drugs such as Fosamax need to have aggressive preventive dental care, and should be warned of the possibility of jaw osteonecrosis, particularly if they need teeth extracted.
At this time, there is no evidence to support discontinuation of bisphosphonate therapy once osteonecrosis develops, or before dental surgery. Still, patients may benefit from the discontinuation of bisphosphonate drugs; there have been reports of healing of jaw osteonecrosis several months after drug withdrawal, so many experts suggest the discontinuation of bisphosphonates for a period of time before and after such dental surgery.
The bottom line is that clinical studies need to be performed to study the dose of drugs such as Fosamax and their effect on the occurrence of osteonecrosis. Studies also would be helpful in demonstrating if there are additional risk factors involved in the occurrence of osteonecrosis of the jaw.
Finally, it is important to emphasize that while Fosamax has gotten most of the publicity lately regarding the jaw osteonecrosis issue, this may be because there are more patients on Fosamax compared to competitors such as Actonel and Boniva, so naturally there might be more episodes of jaw osteonecrosis in terms of absolute numbers. Again, good scientific studies must be performed to assure patients.
I would not suggest wholesale discontinuation of osteoporosis treatment with bisphosphonate drugs unless there are the dental concerns discussed above. These drugs are too important in the fight against osteoporosis and osteoporotic fractures.
Published On: July 13, 2006