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Osteonecrosis of the jaw and bisphosphonates

Bisphosphonates are drugs commonly used to prevent and treat osteoporosis in post-menopausal women.

They are widely used in the management of advanced cancers that have metastasized to the bone, where the disease often causes bone pain and possibly even fractures.
Several cancers can metastasize to the bone, including lung, breast, prostate, multiple myeloma and others.

A serious and disabling complication of bisphosphonate treatment, osteonecrosis of the jaw, has been described in a total of 99 cases in two large case series.

ADRAC ( Australian Adverse Drug Reactions Advisory Committee ) has received nine such reports.

Most of the cases have occurred following intravenous Pamidronate ( Aredia, Pamisol ) and/or Zoledronate/Zoledronic Acid ( Zometa ) therapy for malignancy, but several have occurred after oral treatment with Alendronate ( Fosamax ) or Risedronate ( Actonel ) for osteoporosis.

Of the published cases, 82% followed dental surgery.

Presentation includes jaw pain, toothache, exposed bone and possibly also altered sensation and recurrent soft-tissue infection.
The condition results in chronic pain and disfigurement and is resistant to treatment. Early diagnosis may reduce morbidity.

ADRAC advises prescribers to have a dental review conducted of patients scheduled to receive intravenous bisphosphonates, so that dental procedures can be completed prior to commencement of therapy.

Patients and their dentists should be advised of the risk of osteonecrosis of the jaw so that any 'toothache' developing during treatment can be fully assessed for cause before treatment of the tooth commences.

Source: Australian Adverse Drug Reactions Bulletin, 2005