Bisphosphonates Increase Bone Disease Risks Following Tooth Extraction

We’ve been following risks associated with bisphosphonate (BP) drugs. As we’ve explained, some bisphosphonates, like Fosamax, Boniva, and Actonel, are approved to treat bone-weakening diseases like osteoporosis and Paget’s disease. Cancer patients often undergo therapy with Aredia, Zometa, and other bisphosphonate drugs to prevent fractures from bone metastases.

A recent study has revealed that risks for developing osteonecrosis of the jaw (ONJ) following dental extractions raises significantly in patients taking BP medications, when compared with patients not taking these medications, said MedWire News. In fact, the risk was even more increased in patients who received intravenous BP versus those on oral BP, said the researchers. The study appears in the International Journal of Oral and Maxillofacial Surgery.

The team also found that risks for BP-induced ONJ (BIONJ) were linked to alveolar bone loss in patients who received BP following extraction. This, explained MedWire News, suggests that severe periodontitis may be a risk factor for the condition. “Preventive and therapeutic treatment of oral bacterial infection before extraction might be important in preventing BIONJ in patients with BP administration,” said Masashi Yamori (Kyoto University, Japan) and co-investigators, according to MedWire News.

The team reviewed data from 3216 patients who underwent tooth extraction from April 2006 to June 2009; 126 received BP. Of these, 78.6% were taking BPs orally; the remaining 21.4% received BP intravenously, said MedWire News. Five patients who received BP developed ONJ compared with one who did not, pointing to a significantly increased cumulative incidence for ONJ linked to BP use. Use of intravenous BP resulted in a significantly higher incidence of ONJ than when taken orally, report the researchers.

When investigating for potential BIONJ risk factors in patients who received the drug, the researchers found that median bone loss scores were significantly higher in patients who developed ONJ compared with those who did not, indicating more severe periodontal disease, MedWire News explained. “This study provides important information for physicians and dentists concerned with the prevention of ONJ in patients receiving BP,” the study authors concluded.

We recently wrote that dental extractions appear to be a major trigger for ONJ in people receiving BPs to treat multiple myeloma or Waldenstrom’s macroglobulinemia, according to an Italian study published in the Blood Cancer Journal. Researchers found that a full 80% of the BP ONJ patients studied underwent recent dental alveolar surgery, including tooth extraction, prior to their development of the condition. All of the patients received either Zometa or Aredia. This study involved an analysis of medical records on patients from 10 medical centers being treated for either blood cancer. A total of 55 were identified as victims of ONJ; all but one underwent some sort of dental work.

In 2005, the U.S. Food & Drug Administration (FDA) ordered that warnings about ONJ be added to labels for Fosamax and other bisphosphonates. It is believed that osteonecrosis may develop when bisphosphonates prevent the body from repairing microscopic damage to the jawbone, such as what is seen during routine dental procedures.

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