Do all bisphosphonates cause osteonecrosis?
Table of Contents
Do all bisphosphonates cause osteonecrosis?
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.
How can you prevent bisphosphonate-related osteonecrosis of the jaw?
Conclusions: Preventive oral and maxillofacial treatment before bisphosphonate application combined with 3-monthly dental follow-ups significantly reduces the occurrence and risk of BRONJ in PC patients.
How common is osteonecrosis with bisphosphonates?
The prevalence in patients taking oral bisphosphonates is very low, ranging from 0.07 to 0.10 percent,2 although it is considerably higher in patients with cancer who are taking high-dose intravenous bisphosphonates. Osteonecrosis related to bisphosphonates occurs almost exclusively in the jaw.
How do bisphosphonates cause osteonecrosis of the jaw?
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is thought to be caused by trauma to dentoalveolar structures that have a limited capacity for bone healing due to the effects of bisphosphonate therapy. See the image below. Exposed, necrotic bone in the left anterior maxilla.
How can you prevent osteonecrosis?
Prevention
- Limit alcohol. Heavy drinking is one of the top risk factors for developing avascular necrosis.
- Keep cholesterol levels low. Tiny bits of fat are the most common substance blocking blood supply to bones.
- Monitor steroid use.
- Don’t smoke.
How long does it take for osteonecrosis of the jaw to develop?
Osteonecrosis of the jaw is diagnosed when exposed, necrotic bone is present in the maxilla or mandible for at least 8 weeks.
Is there an alternative to bisphosphonates?
In recent years, the drug denosumab (Prolia) has emerged as an alternative to bisphosphonates for the treatment of postmenopausal osteoporosis. Denosumab may be considered a first-line treatment for women with osteoporosis who are at high risk of fracture or in women who can’t take bisphosphonates.
What are the two main adverse effects of bisphosphonates?
General side effects of bisphosphonates and denosumab
- Fever and flu-like symptoms.
- Low levels of calcium in your blood (hypocalcaemia)
- Bone and joint pain.
- Changes in bowel movements.
- Tiredness and low energy levels.
- Feeling sick.
- Changes to your kidneys.
- Irritation of the food pipe (oesophagus)
Is osteonecrosis reversible?
Treatment for Osteonecrosis Medication may be able to reverse bone damage if osteonecrosis is diagnosed before it is advanced. If the disease has caused severe damage, surgeons who specialize in joint-preserving and joint-replacement surgeries can perform procedures designed to improve mobility and relieve pain.
Can osteonecrosis be reversed?
Treatment can slow the progress of avascular necrosis, but there is no cure. Most people who have avascular necrosis eventually have surgery, including joint replacement. People who have avascular necrosis can also develop severe osteoarthritis.
Is osteonecrosis of the jaw reversible?
Osteonecrosis of the jaw is a rare side effect of some drugs for osteoporosis and cancer. But early detection, specialized dentistry, and oral surgery can cure it.
What are the first signs of osteonecrosis of the jaw?
Symptoms and signs can include:
- pain or swelling in the mouth.
- non-healing of a tooth socket after removal of teeth.
- loosening of teeth.
- an area of exposed bone in the mouth.
- poor healing or infection of the gums.
- numbness or the feeling of heaviness in the jaw.
- discharge of pus.
Who should avoid bisphosphonates?
Avoid oral bisphosphonates in patients with esophageal disorders such as achalasia, esophageal stricture, esophageal varices, Barrett’s esophagus, inability to stand or sit upright for at least 30 minutes, history of bariatric surgery (Roux-en-Y gastric bypass).
What is the danger of taking bisphosphonate medications over a long time?
Long-term bisphosphonate therapy has been linked to a rare type of thigh fracture. This injury, known as atypical femoral fracture, is similar to a stress fracture, causing pain that begins subtly and can gradually worsen. If not identified early on, a complete fracture of the thighbone can occur.
