Bone death of the jaw from fosamax

Osteonecrosis (Bone Death) of the Jaw Associated With
Bisphosphonates (i.e. Fosomax)

According to researchers, bisphosphonate medications, (e.g., Fosamax, Actonel, Boniva) affect the balance between the
bone building cells (osteoblasts) and bone breakdown cells (osteoclasts), and shorten the lifespan of osteoclasts, thus
tilting the balance in favor of the bone-making osteoblasts in helping prevent osteoporosis. Although this action by
bisphosphonates helps compression fractures in the spine, hip and other skeletal regions; there is a downside. Scientists
indicate that bisphosphonates, by disrupting this delicate balance of osteoclasts and osteoblasts, may inhibit new vessel
formation, thereby impairing healing. Apparently, this is found to happen mainly in the jaw, triggered by tooth
extraction.
Many patients are on bisphosphonate medication to prevent or treat osteoporosis, or as part of cancer treatment therapy.
Some bisphosphonate medications (e.g., Fosamax, Actonel, Boniva) are taken orally to help prevent or treat
osteoporosis and Paget’s disease. Other bisphosphonates, such as Aredia, Bonefos, Didronel or Zometa, are
administered intravenously as part of cancer therapy to reduce bone pain and calcium imbalances associated with cancer
of the bone.
Let’s review how the jaw bone can actually die as a result of bisphosphonates:
The most important factor is the time of exposure to bisphosphonates. Bisphosphonate-related osteonecrosis (bone
death) of the jaw still is a rare phenomenon. Since first reported in 2003, 1,500 cases have been documented, most often
triggered by tooth extraction and in patients who have received bisphosphonates intravenously for an extended period of
time (more than 35 infusions in a 40-month period). Less invasive dental work, such as the filling of cavities, the
placing of crowns and root canals, do not trigger the condition.
The mechanism behind why only the jaw is affected is not completely understood. The theory is that the blood supply is
very rich in the jaw and somehow the bisphosphonates disrupt the bone’s ability to heal because they are more highly
concentrated in the jaw bone.
It is not recommended that patients stop taking bisphosphonates. A broken hip or vertebral fracture can cause more
devastating effects. The problems associated with osteonecrosis of the jaw hopefully can be avoided with excellent
dental hygiene; and once the mechanism is understood, this side effect may be eliminated.
In the meantime, here’s a good recommendation for doctors and patients: If a course of bisphosponates is necessary,
take care of major dental work first; and then be very diligent in maintaining excellent oral hygiene to reduce the risk of
dental and periodontal infections. Also alert your dentist to the fact that you are taking a bisphosphonate, so you can
both make an informed decision about your dental care.
Resources:
Bamias A, Kastritis E, Bamia C, et al. Osteonecrosis of the jaw in cancer treatment after bisphosphonates: incidence and risk factors. Journal of
Clinical Oncology 2005;34:8580-8587.
Durie BGM, Katz M, Crowley J. Osteonecrosis of the jaw and bisphosphonates. The New England Journal of Medicine 2005;353:99-102.
Once again, we must remember that medications do have side effects. In fact, if you can take care of your health
with natural, drug-free means, that is the ideal. Research has shown Osteoporsis can be successfully treated with
exercise and the proper diet, but it takes time and effort. If you really want to be healthy, you will need to put in
the effort. While good health is only natural, it is an ongoing process of diet, rest, exercise and adjustments along
with spiritual and emotional well being. Dr. DeFabio

DeFabio Chiropractic Associates
The Natural Way to Better Health and Fitness

Source: http://defabiochiropractic.com/clients/8769/documents/article_001_bonedeathjaw.pdf