Osteoporosis News:

Some Common Osteoporosis Drugs Thought to Cause Painful Jaw Decay in Rare Cases

Some of the drugs most widely used to prevent and treat osteoporosis -- bisphosphonates such as Fosamax, Actone, Boniva, and Zometa -- are now believed to cause a painful and irreversible decay in the jaw in rare cases.

With millions of women now taking these drugs to protect their bones from osteoporosis, the number of cases of this rare disease called osteonecrosis of the jaw (ONJ) -- in which a patient's jawbone rots and dies -- is expected to increase.

The National Osteonecrosis Foundation reports that between 10,000 and 20,000 Americans a year are diagnosed with osteonecrosis, and says anecdotal evidence suggests the number of jaw cases is on the rise.

The Los Angeles Times says that since 2001, more than 2,400 patients taking bisphosphonates have reported bone death in their jaws, most after a minor trauma such as a tooth extraction.

Salvatore Ruggiero, chief of oral surgery at the Long Island Jewish Medical Center in New York, told the Wall Street Journal that 22 of the 155 ONJ cases he has come across involve patients taking Fosamax or other oral bisphosphonates.

"We've uncovered about 1,000 patients with ONJ in the past six to nine months alone, so the magnitude of the problem is just starting to get recognized," Dr. Kenneth M. Hargreaves, chair of the endodontics department of the University of Texas Health Science Center in San Antonio, told the Times.

While early reports of cases of ONJ involved patients wit metastatic cancer who were being injected with potent intravenous forms of bisphosphonates, some oral surgeons now believe oral bisphosphonates can also cause jawbone death when taken over a lengthy period.

"With the oral drugs like Fosamax, exposure time is the key," Dr. Ruggiero said.

In the past year, pharmaceutical companies have amended the labels on bisphosphonate drugs to reflect the possible connection between ONJ and bisphosphonates.

But Merck, developer of Fosamax, insists that "in all of our controlled clinical trials, including the 10-year data with Fosamax, which have included more than 17,000 patients, we have not had reports of osteonecrosis of the jaw occurring in patients taking Fosamax."

Nevertheless, the American Association of Endodontists (the dental specialists who perform root canals) in March issued a statement recommending that dental surgeons check whether patients are on bisphosphonates.

Source: Medical Week staff, week of May 10, 2006