"Dead Jaw": How Serious a Concern?

Patient Expert

"[Bisphosphonate] usage has been linked to the catastrophic condition 'Dead Jaw.' If you or a loved one have taken any of these drugs for osteoporosis" & you have experienced complications, you must act now You may deserve compensation. For a free confidential case evaluation""

So reads the callout on a particular Web site devoted to "litigation regarding Bisphosphonate Complications."

Contrast that with this, from modernmedicine.com, "an online resource designed to meet the evolving needs of physicians," November 15, 2008: "The last word on this controversy [the connection between bisphosphonate use and ONJ] has yet to be said, but according to a review of the literature by the American Society for Bone and Mineral Research, the risk of ONJ associated with oral bisphosphonate therapy for osteoporosis seems to be low, estimated between 1 in 10,000 and <1 in 100,000 patient treatment years."

ONJ. "Bis-Phossy Jaw." Dead Jaw. Certain law firms are trying to turn it into a money-making opportunity. The media has picked up on it, as the first lawsuits involving Fosamax and ONJ are picking up steam. What's the story here?

Osteonecrosis of the jaw (ONJ) has been listed as a possible potential side effect of oral or IV bisphosphonate use. If you take Fosamax, Boniva, Actonel, or Reclast, you may have heard of this serious bone disease. In its milder forms, it slows healing after dental work; a tooth extraction or periodontal surgery may be accompanied by hard-to-treat infections. In a worst-case scenario, ONJ can actually kill parts of your jaw, leading to removal of bone and possible facial disfiguration.

Like leprosy, the Ebola virus, or those flesh-eating bacteria we sometimes hear about, ONJ sounds like a terrifying condition, one that actually mutilates you physically. So how much should you fear becoming a victim of ONJ? Probably as much as you fear leprosy, Ebola, and flesh-eating bacteria. In other words, it shouldn't be one of your day-to-day worries.

Nor should it stop you from taking bisphosphonates, if your doctor has prescribed them for osteoporosis. Especially if youâ�™re a postmenopausal woman with no other serious health issues, such as rheumatoid arthritis or diabetes. The FDA has examined the connection between hisphosphonates and ONJ, and has ruled that doctors should "stay the course" with bisphosphonates.

A report from the The European Society For Clinical And Economic Aspects Of Osteoporosis And Osteoarthritis, printed on The International Osteoporosis Foundation's Web site, sums it up nicely: ""it is important to emphasize that although this condition [ONJ] is very serious it does not significantly impact on the risk-benefit ratio for the use of bisphosphonates in osteoporosis for the prevention of fragility fractures, which are themselves associated with much greater morbidity than ONJ and a mortality that ONJ is not known to possess."

In other words, fear of ONJ should be a non-factor when you're deciding whether or not to use a bisphosphonate. Instead, focus your concerns on what NOT using a bisphosphonate might mean: a real risk of fractures, fractures that can be debilitating or even fatal.

A final word: The ONJ furor isn't completely unfounded. Over 600 lawsuits have been filed against Merck, manufacturer of Fosamax, from women who claim to have developed ONJ while using the drug. These women say Fosamax led to "swelling or infection of the gums, loose teeth or toothaches, pain in the jaw and exposed bone inside the mouth." The first of those suits will come to trial next August in New Jersey.

Want to cover all the bases? If you're taking a bisphosphonate, be diligent with your oral hygiene. And tell your dentist what you're taking; (s)he may take special precautions when treating you just in case.