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Overview
In spring 2006, several news articles1-5 have addressed the topic of osteonecrosis of the jaw (ONJ) and bisphosphonate use. Bisphosphonates are a class of bone-strengthening drugs used to inhibit bone loss associated with cancer, Paget’s disease of the bone, osteopenia and osteoporosis.
There are two routes of administration for bisphosphonates, orally and intravenously. Oral bisphosphonates, such as Fosamax, Actonel, Boniva, Didronel and Skelid, are commonly prescribed for the treatment of bone loss in individuals with osteopenia or osteoporosis. Intravenous bisphosphonates, such as Zometa, Aredia, Didronel and Bonefos, may be administered to reduce bone pain, hypercalcemia of malignancy, and skeletal complications in cancer patients who develop primary lesions of bone or skeletal metastases.
It is essential to note that the risks for developing osteonecrosis of the jaw are much higher for cancer patients on intravenous bisphosphonate therapy than for patients on oral bisphosphonates. Bisphosphonates administered intravenously are taken up much more readily by bone. This may be why the risk for developing osteonecrosis in cancer patients on intravenous bisphosphonate therapy is higher than for patients taking the oral formulations. While there is some uncertainty in this area, current evidence suggests that the majority of cases of osteonecrosis have occurred after dental procedures that traumatize the bone, such as tooth extraction. Although less common, osteonecrosis appears to occur spontaneously in patients taking these drugs.
Novartis, the manufacturer of Zometa and Aredia, convened an expert panel to develop recommendations for the prevention, diagnosis, and treatment of osteonecrosis of the jaws  (Adobe PDF) in cancer patients. The recommendations include a dental examination and the completion of any necessary invasive treatment before initiating therapy with intravenous bisphosphonates (or as soon as possible once therapy is initiated). For patients currently taking intravenous bisphosphonates, it is recommended that invasive dental procedures be avoided if possible.
In addition, the American Academy of Oral Medicine published a position paper on managing the care of patients with osteonecrosis of the jaw. Dentists should refer to these documents for complete recommendations on the management of cancer patients on intravenous bisphosphonate therapy and patients with osteonecrosis of the jaw. It is important for dentists to carefully monitor patients receiving bisphosphonate therapy for signs of osteonecrosis of the jaw (for more information, see A-Z Topic: Osteonecrosis), and to advise the prescribing provider or the patient's primary care physician, as appropriate. Recommendations for managing patients on oral bisphosphonate therapy are currently under development.
Footnotes
1 Health mailbox: Osteonecrosis of the jaw. Wall Street Journal, April 25, 2006.
2 Osteoporosis Drugs Blamed for Jaw Rotting Disease. DailyNewsCentral, April 15, 2006. Available at: “http://health.dailynewscentral.com/content/view/2209/ ”. Accessed May 8, 2006.
3 Painful Jaw Decay Tied to Osteoporosis Drugs. CBC News, Health and Science, May 5, 2006. Available at: “http://www.cbc.ca/story/science/national/2006/05/05/jaw-necrosis.html “. Accessed May 8, 2006.
4 Bisphosphonates May Put Patients At Risk For Deterioration Of The Jaw, American Association Of Endodontists. MedicalNewsToday, April 3, 2006. Available at: “http://www.medicalnewstoday.com/medicalnews.php?newsid=40774 ”. Accessed May 8, 2006.
5 Kolata G. Drug for Bones is Linked to Jaw Disease. The New York Times, June 2, 2006. Available at: "http://www.nytimes.com/2006/06/02/health/02jaw.html?hp&
ex=1149307
200&en=add01a0
366c2bcf3&ei=5094&partner=homepage ". Accessed June 2, 2006.
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A–Z Topic: Osteonecrosis of the Jaw
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Science in the News is a service by the American Dental Association (ADA) to present current information about science topics in the news. The ADA is a professional association of dentists committed to the public's oral health, ethics, science and professional advancement; leading a unified profession through initiatives in advocacy, education, research and the development of standards. As a science-based organization, the ADA's evaluation of the scientific evidence may change as more information becomes available. Your thoughts would be greatly appreciated.
Page Posted May 2006
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