Bisphosphonates, the new class of drugs that are used orally for osteoporosis and intravenously for bone metastases in cancer ironically cause bone degeneration.
The degeneration is called osteonecrosis and generally affects the jaw. Frankly it is death of bone tissue and seems to be due to the drug reducing the ability of the bone to heal, so any trauma to the jaw, especially after dental work, results in irreparable bone damage and so the bone begins to die.
All of the bisphosphonates have this effect. There is also another drug that does this. It is a nonbisphosphonate that acts on bone remodeling, the monoclonal anti-RANK antibody drug called denosumab.
Using bisphophonates for less than 2 years increases the risk of osteonecrosis by 10 times, and use longer than 2 years increases risk by 40 times. The intravenous use in cancer however raises the risk by 300 times.
The risk is further increased by any oral infection with suppuration, having a dental extraction, being anaemic, or having radiation for head and neck cancer.
Takeaway. Although the risk for this complication is low, and a hip fracture has a very high risk for death, the consequence of the use of this drug are very difficult to manage. There is also an increased risk to atrial fibrillation with bisphosphonate use. Previous studies have also pointed to atypical fractures occurring due to drug use so the bone tissue being formed while on this drug is abnormal. There are many well documented natural bone building nutrients and strategies available so maintaining bone health needs to be a significant focus for your wellness program for both women and men who you think are at risk to bone fracture.
Reference. Fellows JL, Rindal DB, Barasch A, Gullion CM, Rush W, Pihlstrom DJ, Richman J. ONJ in Two Dental Practice-Based Research Network Regions. J Dent Res. 2011 Feb 11. [Epub ahead of print]
Abstract – http://jdr.sagepub.com/content/early/2011/01/04/0022034510387795.abstract
