Jaw Problem Tied to Bisphosphonates
Cancer patients undergoing bone-saving therapy show tendency toward osteonecrosis.
Researchers at the New York Harbor Health Care System,
“We are probably the fourth or fifth study looking at this and the findings have all been similar,” said lead investigator Omar Murad, MD, an endocrinology fellow at the State University of New York,
He said these findings should be of particular concern to urologists who are managing prostate cancer patients on IV bisphosphonates. He recommends that physicians counsel their prostate cancer patients to have a dental checkup before starting on parenteral bisphosphonates.
Dr. Murad, who presented the study findings at annual meeting of The Endocrine Society, said the prevalence of ONJ was estimated to be 1 in 72 for the patients in this study who received IV bisphosphonates. The overall prevalence of ONJ is approximately 1 in 1,000 in all the cases reviewed (with and without bisphosphonate use). In the general population, the prevalence currently is estimated to be 1 in 2,200-5,000 among adults.
Although the number of ONJ cases may be low right now, this is a serious issue because so many adults are taking bisphosphonates, Dr. Murad said. Patients without cancer who are taking oral bisphosphonates may be at very low risk, but that may not be the case for patients receiving cancer therapies and parenteral bisphosphonates.
“These patients already have a deterioration of their quality of life because of their cancer and their chemotherapy and steroids. Now they have a hole in their jaw and they cannot eat. They cannot drink and it is extremely painful and all the clinicians are doing today is just helping to control the pain.”
Little is known about ONJ, for which no universally accepted definition exists. The condition typically appears as an area of exposed bone in the lower or upper jaw. Often, this exposed bone develops after a recent tooth extraction, mouth injury, or dental surgery for infection. However, cases of ONJ have occurred when there is no known preceding injury.
Insufficient data exist at this time to construct evidence-based guidelines for prevention and treatment of ONJ. Patients on bisphosphonate therapy for cancer, osteoporosis, or Paget's
disease should seek medical advice before any invasive dental procedures, according to the American Society for Bone and Mineral Research. The society announced in July that it is forming a new task force to help examine the relationship between bisphosphonates and ONJ. Patients beginning or taking bisphosphonate therapy should be informed of possible risks, including ONJ.