Bisphosphonates Associated With Osteonecrosis

Dentistry Today


The use of bisphosphonates (eg, Zomeda, Aredia, Fosamax) has been associated with spontaneous necrosis of the jaws or necrosis following minor oral surgery, according to an article by Leon A. Assael, DMD. Bisphosphonates bind to bone and prevent osteoclast activity, resulting in denser and less vascular bone. Although millions of patients have taken bisphosphonates, only hundreds have appeared with osteonecrosis of the jaws. The author suggests that high dosages of the medication in oncology patients represent the majority of osteonecrosis cases. The most severe cases appear to occur in patients with metastatic cancer and myeloma, which compromise the bones and can cause anemia. Smoking and diabetes may also make the problem of osteonecrosis, if it occurs, more severe. The author recommends careful dental management of patients who are taking bisphosphonates. Mucosal trauma, tooth extraction, or minor oral surgery can be an inducing factor for severe osteonecrosis. The author also suggests that eugenol pastes should not be used for dry socket with patients taking bis-phosphonates. Any necessary alveoplasty should be accomplished at the time of extraction.

(Source: Membership Matters, The Newsletter of the Oregon Dental Association, Vol. 11, No. 1, May 2005)