Fosamax and jaw osteonecrosis

The NY Times spreads the panic. I wrote about this recently. Dr. Centor and Dr. RW chime in.

Bottom-line: this is a rare complication mostly found in IV bisphosphonates used to treat cancer. The benefits of Fosamax and other oral bisphosphonates continue to outweigh this rare risk.

Comments

NeoNurseChic
I still like how my internal med doctor chooses to deal with this. I have AVN of both knees that I most likely got from taking many steroid tapers. I also have osteopenia from the same thing. My doctor recently mentioned that she may want me to start on a bisphosphonate. I told her about my concerns…afterall, google alerts on AVN/ON dump about 5 emails a day on this topic! I knew it was rare and what the cases consist of, but having been a rare case of AVN already, I was more nervous than I normally would be.
She told me that she has her patients stop the med at least one week before invasive dental procedures and wait a week before starting it again. She said these dental procedures appear to be the only time patients got the AVN of the jaw when taking the bisphosphonates. She also said that she knows dentists think she is paranoid because even still, she is more cautious than she needs to be on this, but I really appreciated what she said.
While I have concerns about AVN, it still would be worse not to take the bisphosphonate and then end up with a broken hip or something. But I was lucky and my DEXA scan was about the same as the last, so I don’t need to go that route yet. That made me the most relieved of any option.
Even though it’s a very very rare complication, it does make those of us with AVN already a little nervous. I certainly regret all the steroid tapers I took as now retrospectively they didn’t help enough to be worth the AVN, but there’s no going back – we made the best decision we could with the information we had at the time. I just don’t want to feel the same way after taking a bisphosphonate – but I don’t think that would be the case as long as I followed the advice of my internal med doc when I do need to take one.
Like pulling teeth
I think you are minimizing and taking too cavalier an attitude about biophosphonates and jaw death after dental work. The fact is practioners used to only see this complication in the patients you mentioned. That has changed…and studies to evaluate exactly how prevalent the complication is are only just beginning. You have no good data to assert that the risk is inconsequential.
Liz
I agree with the above comment. You are minimizing the risk of jaw death with longterm use of Fosamax and other bisphosphonates. Doctors seem to be woefully misinformed on this issue. Stopping Fosamax a week before dental work will have NO effect since it stays in the system for at least 10 years. If this is such a rare side effect how come oral surgeons are refusing to do dental extractions on women who take Fosamax? We’re following this story over at our bone health blog. If you want the latest news from an unbiased perspective come check us out. Got Bones?
Jeffrey Dach MD
Bisphosphonate drugs for Osteoporosis, like Fosamax and Actonel, are taken up by osteoclasts with resulting loss of osteoclast activity and inhibition of bone resorption, and bone remodeling.
Although DEXA scanning confirms increased bone density and studies such as the FIT suggest reduced fracture rate, Susan Ott, MD raises questions about the long term safety of bisphosphonates. Although the bisphosphonates appear to have short term benefits, she speculates that after 5 years of use, there is severe suppression of bone formation with negative effects such as microdamage and brittleness.
Spontaneous Fractures of the Mid-Femur
Jennifer P. Schneider, MD, PhD reports a 59-year old previously healthy woman on long-term alendronate. While on a subway train in New York City one morning, the train jolted, and the woman shifted all her weight to one leg, felt a bone snap, and fell to the floor, suffering a spontaneous mid -femur fracture. This is not an isolated report.
Avacular Necrosis of the Jaw
Dimitrakopoulos reports on 11 patients presenting with necrosis of the jaw, claiming this to be a new complication of bisphosphonate therapy administration, i.e. osteonecrosis of jaws. He advised clinicians to reconsider the merits of the rampant use of bisphosphonates. Osteonecrosis of the jaw is a common finding in pycnodysostosis. The bisphosphonates recreate the same clinical profile of spontaneous mid femur fractures, failure of bone healing and jaw necrosis which tormented the famous French artist, Toulouse Lautrec.
The bottom line is that bishosphonate drugs are creating a generation of women with Toulouse Lautrc’s Diseae.
For links to references and more information see my newsletter:
Fosamax, Actonel, Osteoporosis and Toulouse Lautrec’s Disease
Jeffrey Dach MD
mark nimda
how come these Fosamax concerns have died? Its now 2009 and we dont hear much about them anymore?

Fosamax and jaw osteonecrosis

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