Jaw Necrosis and Osteoporosis Drugs

Bisphosphanates are a group of drugs commonly used to treat osteoporosis; they include Fosamax, Actonel and Boniva. In 2003 reports began to surface of jaw necrosis occurring in patients being treated with Bisphosphanates. Osteonecrosis is the infection and subsequent break down of bone, and jaw necrosis is osteonecrosis of the jaw.

Patients report a numbness of the jaw which then progresses to facial swelling, infection and pain. Teeth become loose and may be lost; gums recede, often dramatically and in rare instances the bone is exposed. These symptoms may occur after the patients have been on the drug for some time. The risk is increased by any kind of oral damage, such as tooth extraction or radiation therapy. It is thought that the bisphosphanates reduce the formation of new blood vessels in the jaw, so reducing blood flow and the body’s ability to fight bacterial attack. The mouth is full of bacteria and so the combination of increased attack, through tooth extraction for instance, and reduced fighting ability, from reduced blood flow, leads to infection. This in turn can lead to tooth loss, and then bone loss. If left untreated the bones may collapse and the damage be irreversible.

The typical symptoms of osteonecrosis of the jaw include swelling of the soft tissue of the jaw with pain and signs of infection, drainage of pus may occur into the mouth. In severe cases teeth are lost and the bone may even be exposed. The actual rate of developing jaw necrosis is very low, but because lots of patients are taking it, the actual number of patients affected is high.

There is an increased risk in patients undergoing dental work and a recent history of dental work seems to increase the risk by as much as tenfold. The American Dental Association issued warning to the public in August 2006. As the absolute risk of developing osteonecrosis is low, but unpredictable, it is recommended that patients take certain precautions. If you are taking a bisphosphanate report it to your dentist, if you are unsure tell your dentist anyway and they will advise you. If you require any dental work the dentist may well ask you stop taking your bisphosphanates and return at a later date.

You should maintain good oral hygiene, and report any symptoms of infection, pain, swelling or numbness to your dentist. X-rays may be necessary to decide if there is an infection. It is unlikely that any treatment except antibiotics will be commenced initially as any added trauma at the site could well make things worse.

Osteonecrosis is a very serious side effect of all bisphosphanates, whether taken orally or by injection. The absolute rate, that is number of patients per one hundred thousand, is low but the large number of patients taking these drugs means that a high number of people are affected. The media has led us to believe that this is a very common side effect and scared a lot of people out of taking the drugs. The consequences of not taking the drug may be even more severe. Osteoporosis can lead to death following falls and as many as 55% of the population over fifty have some degree of osteoporosis.