Patient Information
Patients on Osteoporosis Medications
Osteoporosis medications are widely used, and provide an excellent benefit for patients with this condition in keeping their bones strong. The most common Osteoporosis medications are drugs such as Fosamax, Actonel, and Boniva. These drugs are in a category of medications known as Bisphosphonates. Routine dental care, even oral surgical procedures, can usually still be performed safely in these patients, so in most cases, there is no reason to postpone any needed dental treatment because of these medications. These medications are taken in the oral form, although in recent years there has been a new drug regimen which involves a once a year intravenous treatment (Reclast).
Bone is always "turning over", which means that there is constantly bone being resorbed (dissolved) as well as new bone being deposited. Throughout your life, this constant resorption and deposition of bone is usually an equilibrium, i.e. equal amounts of new bone being laid down as there is old bone being resorbed. As we age, the bone cells that are dissolving the bone can become more active than the cells that are laying down new bone, so the net result is that the bones become porous and brittle. The Bisphosphonate medications slow down the activity of the cells that are resorbing the bone, but unfortunately, they can also affect the activity of the cells that are laying down new bone. The reason that this may be a problem is that once a tooth has been removed, we are counting on these bone forming cells to fill the empty socket left by the tooth with new bone. Anything that can affect the ability of the body to produce new bone to heal the extraction site is of course, a concern. Why are the jaws singled out, and the other bones less vulnerable? The reason is that the bone in the jaws is the most rapidly turning over bone in the body. Anything that would affect the ability of the bone to regenerate itself would most profoundly affect the bone where there is the most activity. Despite this, most patients on these medications will go on to heal normally after routine extractions. A very small percentage of the patients on these medications will have delayed healing or lack of healing in the extraction site. This chronically exposed, dead bone is known as Osteonecrosis. Sometimes patients taking Bisphosphonates are also taking other medications such as steroids, that may increase the chances of problems with healing.
If you have had cancer that has spread to the bones, or if you have had a condition known as Multiple Myeloma, you may have been treated with monthly intravenous Bisphosphonate medications, such as Aredia or Zometa. These medicines are given to lower the movement of excessive calcium into the bloodstream when cancer begins to dissolve the bone. This excessive calcium can cause life threatening heart problems, so these powerful medicines are given to stop this influx of calcium into the blood. These Bisphosphonate medications are much more concentrated and powerful than the oral Bisphosphonates like Fosamax, and essentially irreversibly shut down bone healing. Patients that are on these medications may develop severe problems with Osteonecrosis, so dental extractions in this group of patients is avoided completely if it is possible, and there are any other options. Many patients may not be aware that they are receiving these medications for the reasons noted above, and may think that this is simply additional "chemotherapy" for their cancer. Please let us know if you have had any ongoing series of intravenous medications related to cancer treatment.
Increasing numbers of patients (who may have never had cancer) are being seen who are being treated with a once a year regimen of Zometa for their osteoporosis. The drug is marketed as Reclast, but it is the same drug as Zometa. This drug is only given once a year for treatment of osteoporosis, not monthly like the treatments for cancer involving the bone. This regimen has not been around long enough for us to have any long term studies to see if this treatment poses any additional risk over and above the usual risks with the oral Bisphosphonates such as Fosamax.
If you are contemplating any sort of dental or oral surgical procedure, it is important that you provide us with accurate information regarding what osteoporosis medications you are taking, especially the name of the medication and how long you have been taking it. This way, Dr. Digney can determine the best and safest way of managing your care.
For more information about Bisphosphonates please click on the attached link for an article written by Dr. Digney about osteoporosis and jaw problems.