Wednesday Bubble: bisphosphonates…enough to make your jaw drop

Posted by on Jun 2, 2010 in bone health, oral health | 0 comments


Are you being treated for osteoporosis? Has your doctor told you about a rare but extremely serious side effect of drugs known as bisphosphonates that causes the jaw bone to collapse?

Osteonecrosis is a disease that occurs when the blood supply to bone is cut off. This results can result in pain, limited range of motion and an eventual collapse of the bone in the affected area. According to the American Dental Association, reports of jaw osteonecrosis among very small numbers of patients taking Fosamax for osteoporosis started to emerge in 2003.  At higher risk were cancer patients who were receiving intravenous bisphosphonate therapy as part of their treatment. In the majority of patients, osteonecrosis developed after dental surgery.

As I’ve written previously, osteoporosis and low bone mineral density are well-known issues for menopausal women. Studies have shown that after age 35, women (and men) start to lose their bone density at a rate of 0.3% to 0.5% a year.  However, as estrogen levels decline through menopause, the rate of bone density loss accelerates. In fact, during the first five years after menopause, women can experience as much as a 30% loss of bone density. What’s more, experts estimate that by the time a woman reaches the age of 50, she has a 40% risk of suffering a fracture due to osteoporosis for the rest of her lifetime.

Bisphosphonates are frequently prescribed as an alternative to estrogen therapy for preserving bone mass during menopause. Although less than 1% of jaw osteonecrosis have been reported in patients taking oral bisphosphonates, recent research suggests that the majority don’t know about possible side effects. In fact, in this particular study of 71 women and 2 men, 82% said they couldn’t recall or were unsure if their physicians had told them about jaw osteonecrosis.

What you need to know

Taking care of your mouth is essential at any age but particularly during menopause. During the transition, women are especially at risk for altered taste and burning mouth syndrome. Additionally, we are learning that the drugs that we take to prevent loss may actually cause bone death in some women.

The American Dental Association recommends that patients inform their dentist and hygienist that they are taking bisphosphonates to prevent osteoporosis so that extra precaution can be taken before any routine or major dental procedures. if you start to experience the following signs and symptoms while taking bisphosphonates, call your doctor and dentist immediately:

  • pain, swelling
  • gum or jaw infection
  • gums that don’t heal
  • loose teeth
  • jaw heaviness or numbness
  • impaired range of motion
  • exposed bone

Undoubtedly, the benefits of bisphosphonate therapy definitely outweigh the risks. Still, it is unclear whether or not bisphosphonates will ultimately prove to be as risky as HRT, as there have also been reports of  hip fractures in a very small amount of women taking these drugs for five years or more.

Unfortunately, there are few medicinal alternatives available in the United States, although a new drug Prolia, was approved for treatment of osteoporosis just yesterday. I don’t know much about Prolia, other than it is an agent that has been widely used in treating cancer patients. However, there are some early indications that Prolia might also cause jaw osteonecrosis. Only time will tell.

Meanwhile, I can’t emphasize enough that physical activity and ample calcium and vitamin D intake are essential. The risk of doing nothing now? Enough to make your draw drop…literally.

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