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FOSAMAX® and Jaw Osteoporosis Information

FOSAMAX® and Jaw Decay: The Dentist's View

NEW HYDE PARK, NY -- October 13, 2006 -- More dentists are seeking guidance about their patients who are taking FOSAMAX®, a drug used by millions to treat thinning of the bones or osteoporosis. FOSAMAX® has been linked to severe decay of the jaw bone or jaw "osteonecrosis." In osteonecrosis, portions of the jaw bone become exposed or the jaw bone may be completely destroyed. Patients with jaw osteonecrosis do not heal well after any invasive dental procedures.

Osteonecrosis of the jaw was once rare, but dentists are seeing more cases since FOSAMAX® and chemically similar compounds have come into use. In a recent medical journal article, dentists at the Long Island Jewish Medical Center discussed symptoms, risk factors, progression and management of osteonecrosis. In another article, the American Dental Association (ADA) weighed in on treating dental patients who are receiving FOSAMAX® therapy. The discussion that follows is based on these two articles.

From 19th Century "Phossy Jaw" to Jaw Osteonecrosis

FOSAMAX® is the brand name for alendronate, a type of drug called a bisphosphonate, which has two phosphate chains. Bisphosphonates inhibit bone removal or resorption, thereby slowing bone thinning. Some bisphosphonates are injected into the veins ("intravenous" delivery) to reduce bone pain in patients with multiple myeloma or breast cancer. Other bisphosphonates such as FOSAMAX® and Boniva® are taken by mouth and are used to manage osteoporosis.

Published reports of jaw osteonecrosis surfaced in 2003. These cases were associated with intravenous use of the bisphosphonates by cancer patients. Later, dentists realized that oral bisphosphonates such as FOSAMAX® could also be a problem. However, researchers point out that jaw osteonecrosis is not really new, but a disorder that is very similar to the "phossy jaw" reported in workers exposed to white phosphorus during the late 19th century.

Symptoms of Jaw Osteonecrosis

Studies show that patients who take bisphosphonates, whether orally or intravenously, may develop jaw osteonecrosis after tooth extractions and other dental surgical procedures. Sometimes, they have developed the condition spontaneously, when they have not had dental surgery.

Patients may have osteonecrosis of the jaw, yet have no symptoms for months or years. Eventually, some symptoms occur, including:

  • pain, swelling and inflammation
  • loose teeth
  • bleeding gums that do not heal
  • altered sensation in the affected area

These symptoms are similar to other dental conditions, so it is important to let your dentist know if you take FOSAMAX® or other bisphosphonates Your dentist will examine your mouth for exposed bone and also use x-rays to get a more detailed picture.

The longer you use FOSAMAX® or other bisphosphonates, the greater your risk of jaw osteonecrosis. Other risk factors include older age, periodontitis (gum disease) and recent dental surgery such as tooth extractions, root canal work or dental implants.

Once you have jaw osteonecrosis, the condition will not reverse itself just by stopping the use of FOSAMAX® or other bisphosphonates. This is because bisphosphonates remain in the bone for years. They may be doing their damage by disrupting osteoclasts, the cells responsible for removing older bone so that new bone may form. In animal studies, alendronate or FOSAMAX® inhibited repair of microdamage to bones, reducing bone toughness.

Stages of Jaw Osteonecrosis; Treatment Options for FOSAMAX® Users

The dentists at Long Island Jewish Medical Center presented three stages of jaw osteonecrosis, based on observations of 141 patients:

  • Stage 1: exposed jaw bone, no inflammation or infection.
  • Stage 2: exposed bone, related pain, soft-tissue inflammation or infection
  • Stage 3: exposed bone, related pain, soft-tissue inflammation, infection that does not respond to antibiotics, and fistulas or abnormal passages leading from an abscessed tooth

Patients with stage 1 disease may benefit from oral antiseptic rinses such as chlorhexidine, according to the dentists. Patients with stage 2 disease may require long-term antibiotic maintenance or intravenous antibiotic therapy. Because stage 3 patients do not respond to antibiotics and may be in pain, resection of parts of the jaw may be necessary. This is not without risk, and may not always be successful.

The ADA recommends that patients who are about to begin FOSAMAX® therapy have a complete dental evaluation. Those who are taking FOSAMAX®, but who do not have jaw osteonecrosis, should be told that the risk of jaw osteonecrosis cannot be eliminated, but that good oral hygiene and regular dental care may lower that risk.

Getting More Details About Osteonecrosis

The full text of the article by the Long Island Jewish Medical Center group can be purchased online (Oral Surg Oral Med Oral Pathol Oral Radiol Endod.; 2006 Oct; 102(4): 433-41). There is no abstract of the article on the Internet. The ADA article can be accessed for free on the organization's web site. You will need to obtain a copy of Adobe Acrobat Reader to open these files. If you do not already have this software, you may download a free copy at the Adobe Acrobat web site. Also see our discussion about FOSAMAX®, bone decay and jaw osteonecrosis.

Your FOSAMAX® Case

Brayton Purcell has been successfully handling medical/legal cases involving defective drugs for over 20 years. Our attorneys are currently evaluating the legal claims of people who have taken FOSAMAX® and developed serious jaw bone complications or osteonecrosis of the jaw.

Please contact us if you developed these conditions while taking FOSAMAX® or after you stopped taking the drug. We will review your case free of charge and advise you of your legal choices.

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