I have never heard of a benefit, and I would be very careful about
suggesting this.
    There have been recent reports of avascular necrosis and other bony
changes with use of bis-phosphonates.  My oral surgeons are saying they
are becoming hesitant to perform surgery on patients showing
radiographic changes in the bone (similar to osseous displasia) who are
receiving these meds.
    See:

http://annals.edu.sg/pdf200409/V33N4p48S.pdf

Steve

Check this too!

***

Originally Posted by gocanes
Biphosphonates such as Didronel, Fosamax and Zometa are popular drugs
used to treat osteoporosis, Paget's disease, metastatic cancer, and
hypercalcemia, among other things. These drugs inhibit bone turnover
by interfering with osteoclastic activity. Because they bind to
exposed bone at high levels and are not metabolized, they remain in
the area in high concentrations for long periods of time.

I recently had a female patient taking Zometa who abraded a small
torus on her palate and the area would not heal. I sent her to my OS
who levelled the torus and achieved primary closure. The microscopy
was negative for anything beyond inflamed bone tissue. It has been
over a month, the gingiva has sloughed and the area will not heal. She
has about a 1cm X 1cm area of exposed bone on her posterior palate.
The surgeon does not want to re-operate and is contemplating HBO
therapy. I'll post the pictures next week.

I post this as a warning to those who might have a patient on these
drugs who requires any type of oral surgery, even simple extractions.
Your patient is at risk for delayed healing and potential
osteonecrosis. It would be wise to refer to an OMFS unless you know
how to treat such complications.

Here is a citation:

Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL

Osteonecrosis of the jaws associated with the use of bisphosphonates:
a review of 63 cases.
J Oral Maxillofac Surg. 2004 May;62(5):527-34.



Craig,

I read the article as I think that patients need to be advocates for
their own health as well (and I have two friends that are on Fosamax
so I was interested!). BTW, one of these is a male (osteoporosis can
occur in men as well).

My comment.

Besides increased prevalence of post-surgical complications for these
pts, even more disturbing (in my mind) is that for these patients,
their lesions were refractory to conservative debridement and
antibiotic therapy.

Therefore your suggestion to refer these patients directly to OMFS
should be taken very seriously, IMHO.

Thank you for the information.
-Sue
 
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 #1       11-04-2004, 08:00 PM  
gocanes  
Member   Join Date: Oct 2004
Posts: 56  

Osteonecrosis of the Jaws and Biphosphonates

--------------------------------------------------------------------------------

Biphosphonates such as Didronel, Aredia, Fosamax and Zometa are
popular drugs used to treat osteoporosis, Paget's disease, metastatic
cancer, and hypercalcemia, among other things. The manufacturer of
these drugs is now recommending to physicians that a dental
examination and preventive dentistry regimen be implemented prior to
biphosphonate therapy for patients with "concomitant risk factors
(e.g. cancer, chemotherapy, corticosteroids, poor oral hygiene)."

The bisphosphonate class of drugs inhibit bone turnover by interfering
with osteoclastic activity. Because these drugs bind to exposed bone
at high levels and are not metabolized, they remain in the area in
high concentrations for extended periods of time.

I recently had a female patient taking Zometa who abraded a small
torus on her palate and the area would not heal after several weeks. I
sent her to my OS who removed the torus and achieved primary closure.
The microscopy was negative for anything beyond inflamed bone tissue.
It has been over a month, the gingiva has sloughed and the area has
not healed. She has about a 1cm X 1cm area of exposed bone on her
posterior palate. She does not complain of pain. The surgeon does not
want to re-operate and is contemplating HBO therapy. I'll post the
pictures next week.

I post this for consideration and as a potential warning to those who
might have a patient on these drugs who requires any type of oral
surgery, even simple extractions. Your patient is at risk for delayed
healing and potential osteonecrosis/osteomyelitis. It would be wise to
refer to an OMFS unless you know how to treat such complications.

Here is a relevant citation:

Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL

Osteonecrosis of the jaws associated with the use of bisphosphonates:
a review of 63 cases.
J Oral Maxillofac Surg. 2004 May;62(5):527-34.

__________________

--------------------------------------------------------------------------------
Last edited by gocanes : 11-08-2004 at 08:32 AM.


**