Bisphosphonate - related osteonecrosis of the jaw (deaden up the jaw bone) adversely affects the quality of life, producing significant morbidity in afflicted patients.
Experimental and epidemiologic studies have established a firm foundation for a strong association between monthly IV (injectable type) bisphosphonates and jaw necrosis.
Medication such as Aredia, Zometa, Boniva, Reclast used for management of cancer related conditions: breast cancer, prostate cancer, lung cancer, management of osteoporosis, can produce osteonecrosis of the jaw. Estimates of the cumulative incidence of jaw necrosis after the IV administration for a period of three years of the above mentioned medication is between 0.8-12%. Prior to treatment with IV bisphosphonates , the patient should have a thorough oral examination, any unsalvageable teeth should be removed, all invasive dental procedures should be completed. Patients under treatment with oral bisphosphonates such as Fosamax, Actonel, are at a considerably lower risk for jaw necrosis than patients treated with IV Bisphosphonates. The incidence here was calculated to be 0.7/100,000 person/years of exposure.
I strongly believe that there is not enough available and reported data regarding the relationship between ORAL bisphosphonates and jaw necrosis, since last week I saw another very healthy patient that took Fosamax for 2,5 years and went for an extraction in May of '09 and now is presenting with jaw necrosis. It is painful and is not pretty. Takes months of antibiotic therapy, sometimes patients loose half of the jaw, and if the healing occur, there should be monitoring of the area for the rest of the patient life because whenever the immune system is down the jaw necrosis can return.
Patients, please be aware and inform your dentist before any surgery such as extractions, implants, root tip surgery or gums surgery involving bone, if you are taking any of the bone building drugs.