bone density treatment side effects

[Bobb0]

I haven't seen this item discussed, but if this information is old news to everyone please excuse the duplication.

Last week my wife Janet finally had a tooth extraction after three months of agony. We delayed this procedure while looking for any alternative because of our oral surgeons reluctance to extract teeth of any patient currently on or recently receiving biophosphante treatment. Biophosphonate (Fosamax among others) treatment appears to be not an uncommon recommendation for those with lower bone density scores looking to receive disc arthroplasty.

Our oral surgeon, who is the local dental assoc president, has been actively informing the local medical commmnunity about the link between biophosphonates and bone necrosis. He has personally seen multiple cases of this and claims this is not new. While the most prevalent cases involve IV biophosphanates, he indicated oral and nasal treatments have also been culprits. Apparently after an extraction that area of the bone can swell, become exposed, and is at risk for secondary infection. There have been cases of patients losing their entire jawbone according to this doctor. He stated that Janet has a 1-7% chance of developing this condition for up to one year. If this condition were to develope and is treated early the chances are excellent of stopping any further damage.

My intent is not to alarm anyone, but just relay what has been told to us by what we believe to be a cautious health care provider. It may be prudent to be extra vigilant regarding your dental health prior to starting a biophosphonate regiment.

bob

[mmglobal]

Bob... thanks for posting. Here in the spine patient community, we know so many people who are treating for bone density issues... your post may be very important to many of them.

I wonder if, armed with this knowledge, there are things that can be done to avoid serious issues. Also, if serious dental work is needed, can the oral surgeon do something differently to reduce the risk of such issues?

Thanks again... I hope Janet is better.

Talk to you soon,

Mar

[Maria]

I've been advised to have two implants done and was also advised by the Oral surgeons to go off the Actonel for at least 6 months to a year before the implants.

I was so worried about one tooth needing to be replaced as it's up front pretty much I actually stopped my Actonel for nearly 5 months. Also had some ongoing GI issues that made it hard for me to take anything on an empty stomach or wait a half hour to have something to eat, even if a cracker.

Meanwhile I asked the Oral Surgeon when could I go back on this medication and he said " I don't know, ask your GP".

I talked to the GP about and she was mad because she said "look at your hip bone density values and tell me that you don't think saving your hips is more important than that tooth implant"...

Well, I also think Mark may have made this point to me regarding prioritizing my spinal osteopenia and hip osteoporosis re the tooth implant if I recall correctly~

One of the Dental hygienists told me that Boniva actually has the greatest propensity for this bone necrosis.. I asked her about stats and she said that's what the dentists in the group had told her.

Need more info on this but truly if I had to replace my teeth completely I think that's far easier to do than bilateral hip replacements after 2-3 spine surgeries.

I'm hoping I didn't seriously negatively affect my BMD these past months w/o taking the Actonel regularly.

[sahuaro]

My GP also indicated that most of the cases of necrosis occurred with IV biophosphonates and that the occurrence with oral Actonel was negligible. It would be nice to see some of the case reports in the literature to check out the variables involved.
I just had a Dexa scan to determine if I am a candidate for ADR and while anxiously awaiting the results (which took 3 weeks to get!), I fully appreciated my gynecologist's warning that I couldn't just think if I broke my hip that I could get an artificial hip because there would be no bone to attach it to. Fortunately, the Actonel has increased my scores significantly. It may be short-sighted, but right now, my neck and potentially my hip are foremost in my concerns!

[dshobbies]

I read a newspaper article some months ago about a link between jaw necrosis and biophosphonates. Apparantly it is a possible side effect. I asked a pharmacist friend who confirmed this. When Dr. L, looking at my 1 year post op x-rays, told me I had severe osteoperosis, I mentioned this fact. His response surprised me. He asked, after putting all this effort into my back, would I rather my spine fracture or my jaw?

Much to my relief my recent bone scan (Mark, I'll be sending you a copy) did not confirm this. I wouldn't want to have to choose!