Does bisphosphonates cause osteonecrosis?

Asked by: Prof. Janis Gulgowski V
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Recently, however, high-dose intravenous bisphosphonates have been identified as a risk factor for osteonecrosis of the jaw among oncology patients. Low-dose bisphosphonate use in patients with osteoporosis or other metabolic bone disease has not been causally linked to the development of osteonecrosis of the jaw.

Does oral bisphosphonates cause osteonecrosis?

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a chronic condition of the oral cavity resulting in mucosal ulceration and exposure of underlying necrotic bone, and the ensuing secondary complications. As a relatively newly recognised condition, the epidemiology of BRONJ is poorly described.

Do bisphosphonates cause avascular necrosis?

Infrequent side effects associated with bisphosphonate use include pyrexia, renal function impairment, hypocalcemia, and, more recently recognized, avascular osteonecrosis of the jaw.

What are the side effects of bisphosphonates?

Side effects for all the bisphosphonates (alendronate, ibandronate, risedronate and zoledronic acid) may include bone, joint or muscle pain. Side effects of the oral tablets may include nausea, difficulty swallowing, heartburn, irritation of the esophagus (tube connecting the throat to the stomach) and gastric ulcer.

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Who should not take bisphosphonates?

Don't take bisphosphonates if you:
  • Are allergic to them.
  • Have disorders of the food pipe (esophagus), including tears, holes, narrowing, or difficulty swallowing.
  • Have severe kidney disease.
  • Can't sit in an upright position for at least 30 minutes.
  • Have low levels of calcium in your bloodstream.

How long should you stay on bisphosphonates?

Answer From Ann Kearns, M.D., Ph. D. Bisphosphonates, the most common type of osteoporosis medications, are typically taken for at least 3 to 5 years. After that, your doctor will consider your risk factors in determining whether you should continue to take these or other osteoporosis medications.

How do you know if you have osteonecrosis of the jaw?

Symptoms of ONJ can range from very mild to severe. ONJ looks like an area of exposed bone in your mouth. It can cause tooth or jaw pain and swelling in your jaw. Severe symptoms include infection in your jaw bone.

Why bisphosphonates is the drug of choice for osteoporosis?

Bisphosphonate therapy normalizes bone turnover, reduces the number of bone remodeling sites and stress risers, restores the balance of bone remodeling, prevents bone loss and deterioration of bone structure and, in patients with osteoporosis, reduces fracture risk (5).

Which bisphosphonate is safest?

64–66,71,72 Recent publications indicate that the use of oral bisphosphonates (alendronate and risedronate) may be safe and effective in patients with glomerular filtration rates less than 30 mL/min.

How common is osteonecrosis of the jaw bisphosphonates?

Among cancer patients receiving high-dose intravenous bisphosphonates, osteonecrosis of the jaw is dependent on dose and duration of therapy,1720 and has an estimated incidence of 1% to 12%.

Why do bisphosphonates cause Mronj?

The risk of a patient having MRONJ after discontinuing this medication is unknown. There are suggestions that bisphosphonate may inhibit the proliferation of soft tissue cells and increases apoptosis. This may result in delayed soft tissue healing.

Can osteonecrosis of the jaw be fatal?

Even if a negative impact on Quality of Life has been described and demonstrated, ONJ is usually described as an event with mild or moderate sereneness. However, as a form of osteomyelitis with potential severe complications, ONJ can rarely be life-threatening.

What is the treatment for osteonecrosis of the jaw?

Osteonecrosis of the jaw is usually treated with antibiotics, oral rinses, and removable mouth appliances (retainers). Because osteonecrosis of the jaw is rare, doctors can't predict who will develop it. If you're taking a bisphosphonate, tell your dentist right away.

What kind of doctor treats osteonecrosis of the jaw?

Once established, osteonecrosis of the jaw is challenging to treat and should be managed by an oral surgeon with experience treating ONJ. Treatment of ONJ typically involves limited debridement, antibiotics, and antibacterial oral rinses (eg, chlorhexidine; 1 ).

Which drug causes osteonecrosis of the jaw?

Bisphosphonates — such as alendronate (Fosamax, Binosto), risedronate (Actonel, Atelvia), ibandronate (Boniva) and zoledronic acid (Reclast, Zometa) — and denosumab (Prolia, Xgeva) have been linked to osteonecrosis of the jaw and atypical femoral fractures.

Can osteoporosis be reversed without Fosamax?

You cannot reverse bone loss on your own. But there are a lot of ways you can stop further bone loss. If you are diagnosed with osteoporosis or at a greater risk for developing it, your doctor may recommend certain medications to take.

What are the two medications that may cause osteoporosis after long term use?

The medications most commonly associated with osteoporosis include phenytoin, phenobarbital, carbamazepine, and primidone. These antiepileptic drugs (AEDs) are all potent inducers of CYP-450 isoenzymes.

Is sitting bad for osteoporosis?

“If you have low bone density, however, and you put a lot of force or pressure into the front of the spine — such as in a sit-up or toe touch — it increases your risk of a compression fracture.” Once you have one compression fracture, it can trigger a “cascade of fractures” in the spine, says Kemmis.

What is osteonecrosis pain like?

Osteonecrosis develops in stages. Hip pain is typically the first symptom. This may lead to a dull ache or throbbing pain in the groin or buttock area. As the disease progresses, it becomes more difficult to stand and put weight on the affected hip, and moving the hip joint is painful.

What are the stages of osteonecrosis of the jaw?

proposed an ONJ classification comprising three stages (31): stage 1 = bone exposure but without signs or symptoms of infection; stage 2 = bone exposure/necrosis with clinical evidence of infection; stage 3 = the above manifestations and also alterations such as pathological fractures, extraoral fistulas or osteolysis ...

Is osteonecrosis of the jaw curable?

It causes severe and persistent inflammation leading to loss of bone from the jaw and has no effective prevention or cure. The risk, though small, deters people from taking drugs needed to fight bone cancer or prevent fractures due to loss of bone density.

When should bisphosphonates be stopped?

The U.S. Food & Drug Administration has issued guidance, saying that although the optimal duration isn't known, discontinuation should be considered after three to five years for patients with a low fracture risk.

What happens when you stop taking bisphosphonates?

When treatment is stopped, if there is continued presence of bisphosphonate in bone and continued release (and possible re-attachment to bone), there might be some lingering antifracture effect after treatment is stopped.

Should osteopenia be treated with bisphosphonates?

In some cases, especially if you've already broken a bone, your doctor may prescribe medicine to lower your chances for osteoporosis and to prevent more fractures. Medications that can treat osteopenia or prevent osteoporosis include: Bisphosphonates. These meds slow your body's natural process for breaking down bone.