Patients on Osteoporosis Medications

The Problem Drugs

Medications are available in both oral and intravenous form for the treatment of these diseases. The most common drugs on the market are FOSAMAX, ACTONEL AND BONIVA. These oral medications are taken weekly or monthly. RECLAST is a new once a year intravenous medication for osteoporosis and osteopenia.For those patients with certain types of bone cancer, ZOMETA or AREDIA are given intravenously. These medications, known as BISPHOSPHONATES, primarily affect osteoclast function in order to increase bone density. These drugs attach to the bone and can remain for months or even years after they are discontinued.

Conditions Affecting Bone Healing

Development of mature bone depends on new bone forming and then remodeling. Normal bone contains many different cell types and proteins. It is the proper balance of these cells that allows bone to heal. The OSTEOCLAST is the cell responsible for the remodeling of bone. If bone does not remodel properly, new bone will not form.

OSTEOPOROSIS is a disease involving a decrease in bone mineral density, caused by a defect in bone metabolism. The cell primarily involved in this disease is the OSTEOCLAST.

Other diseases involving bone metabolism, such as osteopenia, Paget’s Disease and some types of bone cancer are affected by osteoclast malfunction.

What is BONJ

If new bone is not allowed to form properly due to the effects of the bisphosphonate medications, any trauma to the bone will not heal properly. Many oral surgical procedures, for example tooth extraction, will be affected by the actions of these drugs. When bone cannot heal properly due to the effects of these medications, surgical sites may not get proper blood supply and exposed bone occurs. This condition is known as BISPHOSPHONATE INDUCED OSTEONECROSIS OF THE JAW (BONJ).

BONJ is condition that is difficult to treat, and can result in large areas of exposed bone, infection, intractable pain and potential fracture.

Any patient having a history of taking any of the oral or intravenous forms of bisphosphonates should inform Dr. Sultan immediately!

Patients potentially at risk for developing BONJ from their oral surgical procedure may need to undergo a simple blood test to assess their bisphosphonate levels. Depending on the results of the CTX blood test, patients may need to go on a “drug holiday” for weeks or months prior to their surgery.

Prevention

Remember, most cases of BONJ can be prevented as well as treated by giving a thorough medical history prior to your surgery!