Study Finds Dental Work Triggers Bisphosphonate-Induced ONJ in Blood Cancer Patients

Dental extractions appear to be a major trigger for Ostenecrosis of the Jaw (ONJ) in people receiving bisphosphonates to treat multiple myeloma or Waldenstrom’s macroglobulinemia, says a new study out of Italy.  According to the authors of the report, which is published in the Blood Cancer Journal, a full 80% of the bisphosphonate ONJ patients they studied had undergone recent dental alveolar surgery, including tooth extraction prior to their development of the condition.

Some bisphosphonates, like Fosamax, Boniva and Actonel, are approved to treat bone weakening diseases like osteoporosis and Paget’s disease.  However, cancer patients often undergo therapy with Aredia, Zometa and other bisphosphonate drugs to prevent fractures from bone metastases .  In 2005, the U.S. Food & Drug Administration 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.

This new study involved an analysis of medical records on patients from 10 medical centers being treated for either blood cancer.  A total of 55 patients were identified as victims of ONJ.   All but one of those patients had undergone some sort of dental work.

All of the patients received either Zometa or Aredia.  The study found that the type of bisphosphonate did not influence outcome.  However, the cumulative bisphosphonate dose also played a role in a patient’s predisposition to ONJ.

The study authors advised that a dental exam with preventive dentistry be performed before patients undergo bisphosphonate therapy.   If dental problems appear during therapy, they recommended the use of antibiotics for germ eradication, avoidance of tooth removal and dental implants, and nonsurgical control of periodontal disease.    The researchers also advised clinicians to individualize bisphosphonate therapy for their patients, and warned that patients should not receive continuous therapy for more than 1 to 2 years.

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