|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Bisphosphonates and osteonecrosis - from an OMFSFrom: Kim E. Goldman (goldman@calweb.com)Sun Jun 4 13:27:13 2006
I noted with interest that this topic is being discussed in OB-GYN forums and thought I would share what little we actually do know about this phenomenon. It is, unfortunately, very little but, as many of you have pointed out, the attorneys are ALL on to this already. It has been relatively well known in the oral surgery community for several years now but seems, only recently to have disseminated beyond that relatively small group of health care providers. 1. Bisphosphonate related osteonecrosis (BRON) occurs in a very small percentage of patients on bisphosphonates but when it does occur it can be devastating. 2. BRON is more common in patients receiving IV bisphosphonates but ABSOLUTELY DOES OCCUR in patients on oral medications only for the prevention of or treatment of osteoporosis. 3. In many cases there is some minor oral injury (tooth extraction, denture sore, etc.) which precipitates the disease BUT THERE ARE ALSO CASES WHERE THIS OCCURS SPONTANEOUSLY. 4. Taking patients off bisphosphonates may not lower their risk for an extended period of time or at all. We just don't know. We do know that bisphosphonates have a very long half life in bone. 5. As of yet, there is no clear consensus on treatment though there is a great deal of work being done on clarifying and stratifying treatment modalities. It is still, quite often, a disease with extreme morbidity when it occurs. I believe that we will see increasing numbers of these cases reported. Personally, I have looked backward through my own cases and know of at least one case in the late 90's which must have been BRON. History is as follows. Otherwise healthy female (nurse at our hospital actually) in her late 50's whose only medication was a bisphosphonate. Saw her dentist, had tooth extracted, site didn't heal, tx'd with abx without resolution, referred to OMFS, multiple debridements without healing, referred to our teaching hospital where multiple services including ID were involved, workup for immune deficiency was negative, PICC line and long term abx failed to resolve issue....long story short she eventually lost almost half of her lower jaw. Since that time I have seen, treated or had colleagues in our practice treat several other cases. While the occurences are still relatively rare, as I stated before, when it is you or your patient, it is devastating. I am often asked by patients now what they should do about these drugs and my personal suggestions to patients at this point are as follows: First I share with them how little we actually know about this problem. For patients who will understand, I also provide copies of some of the landmark papers on the issue (Ruggerio et. al, Marx et. al.) I then share the following personal philosophies. 1. No matter what your age now is the time to increase calcium intake, increase exercise and healthy life style choices, build bone mass now to prevent problems later. 2. I would not personally take a bisphosphonate for prevention of osteoporosis. 3. If I were already diagnosed with osteopenia or osteoporosis, I would look into nonbisphosphonate modalities such as Evista and HRT. 4. IF *I* were on bisphosphonates I would discontinue them even knowing that we don't know if this is helpful or reduces risk long term. Teleologically it seems unlikely to reduce short term risk given the long half life of these drugs. 5. For cancer patients who will be placed on IV bisphosphonates I urge restoration of dental health prior to beginning these drugs (as is also advised prior to beginning chemotherapy or XRT)and patient education to understand the risks/benefits of such drugs in these cases. 6. I encourage patients to discuss these issues with the health care provider who is suggesting or prescribing bisphosphonates and always offer to discuss the OMFS literature and experience with those providers so that together with their health care providers they can make the best decision for their individual case.
-- Kim E. Goldman, D.M.D. Associates in Oral & Maxillofacial Surgery, PLC Asst. Clin. Prof. University of Louisville
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Wed Jul 2 04:44:06 2008 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.