Use of Bisphosphonate

Osteonecrosis of the Jaw (ONJ) has captured attention in the past 8 years since the identification of this side effect of bisphosphonates (fosomax, et al).  Bisphosphonates are highly effective in control of skeletal health, such as treatment of osteoporosis and cancer metastasis therapy.  However, in patients on oral or intravenous bisphosphonates, there is an increased risk of BRONJ (bisphosphonate related osteonecrosis of the jaw) after oral procedures that result in exposure of the bone, especially dental extractions or dental implant placement.  The authors found that while the risk with oral bisphosphonates was rare, the risk, while still low, was 30 times higher with the intravenous type.  However, after two years of bisphosphonate therapy, the risk of BRONJ escalated fourfold.   

Source: Journal of Evidence-Based Dental Practice, June 2012

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Popular Bisphosphonates and Risk of Eye Disorders: Ask Your Doctor

A report in the Canadian MedicalAssociation Journal says women taking the popular bisphosphonate drugs to prevent osteoporosis have a 45% increased risk of serious inflammatory eye disorders such as uveitis and scleritis.  These drugs, such as fosomax, are the most common form of medication taken long term by millions of women in a bid to prevent the thinning of bones caused by osteoporosis.  Doctors and patients should be aware of signs such as pain, redness and blurred vision in one or both eyes.  Usually, discontinuing the drug and prompt medical treatment reverses the symptoms.  Other studies have suggested long term use of bisphosphonates might double the risk of esophageal cancer, or cause such side effects as unusual fractures and irregular heartbeats.  Though rare, the adverse side effects must always be taken into consideration.  There is some evidence in the literature that the maximum benefit of bisphosphonate therapy is achieved after two years of treatment.  

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309

Bisphosphonates Delay Healing After Extraction

Risk For BON

Patients taking certain forms of the popular bisphosphonate medications for osteoporosis are at risk for developing BP-associated osteonecrosis (BON).  BON is the presence of exposed necrotic bone for at least eight weeks anywhere in the oral cavity of a person exposed to BPs and who has not received radiation therapy to the head and neck.

Exposed To BPs

As reported in the Journal of the American Dental Association, a controlled study population in Florida, Canada and Norway, between 2007 and 2011, compared patients who were and were not exposed to BPs and needed tooth extraction.  Data was collected and analyzed. By controlling for other factors, the researchers showed that BP exposure is the main factor in delayed healing.  They found that BP exposure inhibits normal mucosal (soft tissue) healing.

Robert G. Tupac, DDS, FACP, Inc., Diplomate, American Board of Prosthodontics (661) 325-1275 | www.drtupac.com 5060 California Ave., #170, Bakersfield, CA 93309