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

Bisphosphonate-Related Osteonecrosis in Cancer Patients

As reported in the American Dental Association Journal, the prevalence of bisphosphonate-related osteonecrosis in patients with cancer could be as high as 13.3%, which is more common than previously thought.  Bisphosphonates are the group of medications commonly used to treat bone weakening in older patients.  An important side effect is the risk, though small, of bone necrosis in sites that are surgically exposed, as in dental extractions or dental implant placement.  The authors examined studies in this area and separated out those with documented follow-up (those in which dental experts participated) and found the rate, in cancer patients, to be 13.3% instead of the previous reported average of 6.1%.  For patients without cancer, the prevalence of BON (bisphosphonate-related osteonecrosis) for patients receiving oral bisphosphonates is 0.10%.  The implications of this new information for the dental practice are: the possibility of deferring oral surgery and considering non-surgical approaches such as root canal therapy, fixed bridgework or removable partial dentures for patients who are receiving antiresorptive therapy.  JADA 2/2012

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