Interesting thread, thanks. I was sent an e-mail during the last
go-round with this that a related condition is known as "Fossy Jaw."

Here is some information from the 'net.

Phosphorus is a necessary constituent of the bones and nerves. But we
must supply it to the body as we find it in plants. Crude rock
phosphorus as it comes from the earth, is a powerful poison. Laws now
prohibit its use in the manufacture of matches, because of its
poisonous character. It particularly affects the jaw bone producing a
condition known as "Fossy jaw." Its continued use, as a medicine, even
in small doses, produces anemia and emaciation. Although so vitally
essential to bone and nerve, phosphorus, when not. "organized," as we
find it in plants, is the most virulent poison of any of the normal
elements of the human body. A man of average size contains, normally,
about two pounds of phosphorus, but two grains of this "disorganized"
(this may be done by calcination of a bone), given to a healthy man,
produces great excitement, particularly of the brain. Delirium,
inflammation and death may be the result in a single hour. Ten times
this amount, taken as nature gives it to us in food, produces no such
trouble.

Phosphorus poisoning is characterized by nervous and mental symptoms,
jaundice, vomiting, general fatty degeneration, the presence of bile
pigments, albumen and other abnormal constituents in the urine,
followed by death.

Chronic phosphorus poisoning was quite common among workers in
match-factories. Necrosis of the jaw bone was one of its frequent
results. It ranks with mercury in its power to wreck the bones.
 
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 #4       Yesterday, 05:13 PM  
Sue  
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Posts: 1,663  

Medscape - March 4, 2005

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

More info.

To Print: Click your browser's PRINT button.
NOTE: To view the article with Web enhancements, go to:
http://www.medscape.com/viewarticle/500884

Jaw Osteonecrosis Associated With Bisphosphonates in Some Cancer
Patients

Reuters Health Information 2005. © 2005 Reuters Ltd.
By Lisa Richwine

GAITHERSBURG, Md. (Reuters) Mar 04 - Novartis AG has received 875
reports of jaw problems in cancer patients treated with two
bisphosphonates, but it is not clear if the medicines are responsible,
company officials told a U.S. advisory panel on Friday.

A Food and Drug Administration official said there was a "highly
plausible" sign the cases were related to the drugs, Zometa
(zoledronic acid) and Aredia (pamidronate disodium). FDA officials
urged further study to determine who might develop the problem and if
steps could be taken to minimize the risk.

Zometa and Aredia are used to treat multiple myeloma as well as bone
metastases from solid tumors.

Novartis added a warning to the labels of both drugs last year to
alert doctors to the reports of osteonecrosis of the jaw, or ONJ. The
severity of the condition varies but it can lead to disintegration of
the jaw, Novartis officials and others told an FDA advisory panel.

"We do not have an understanding of what is causing this to happen in
a small number of cancer patients. Further investigation is
necessary," said Dr. Diane Young, vice president and global head of
clinical oncology development for Novartis.

More than 1 million patients have been treated with Zometa since its
launch in 2001, Novartis said. Aredia is available generically, and
Novartis no longer promotes the brand name version.

"These drugs have been shown to markedly reduce bone pain," while the
risk of ONJ "is a minor one," said Dr. James Berenson, director of the
multiple myeloma and bone metastases programs at Cedars-Sinai Medical
Center in Los Angeles and a Novartis consultant.

The FDA panel did not make any formal recommendations for regulatory
action, but some members said Novartis should do more to alert
dentists, patients and others to the issue. The company said it sent
letters about the cases to physicians last year and contacted patient
groups and printed brochures.

Carol Pamer, a reviewer in the FDA's Office of Drug Safety, said ONJ
is rare but the agency had received a steadily increasing number of
reports of the condition in patients who were treated with Zometa or
Aredia.

"We believe these cases present a highly plausible safety signal" for
the drugs, she said.

Felice O'Ryan, an oral surgeon who traveled from California to testify
before the panel, said she had seen an increase of ONJ cases in her
practice recently, and some cases were severe.

"I do not consider these problems minor or insignificant, nor do my
patients. The FDA and Novartis have done a very poor job of informing
people about this particular risk," she said.
 
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 #3       11-16-2004, 11:37 AM  
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--------------------------------------------------------------------------------

As promised, here are the before and 6 months after-bx photos. There
has been a slight amount of gingival growth around the exposed bone:
Attached Images
   
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Last edited by gocanes : 11-16-2004 at 11:41 AM.
 
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 #2       11-05-2004, 01:41 PM  
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Posts: 1,663  



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

Quote:
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: 71  

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.

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