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Bone density drugs could destroy jawbones

Local dentists are responding to nationwide worries about the use of popular drugs that improve bone density and their possible connection to infections that can destroy the jawbone.

The concerns involve Fosamax, a drug widely taken by cancer patients and post-menopausal women to rebuild bone structure. Studies have linked the use of Fosamax to osteonecrosis – the death of bone tissue.

“People are concerned and sensitive about it,” said Dr. Doug Valentine, a Grass Valley oral surgeon who has handled five cases of osteonecrosis of the jaw he suspects were linked to the active ingredient in Fosamax, a chemical known as bisphosphanate.



In a warning issued in March 2006, the American Association of Endodontists (root canal specialists) said bisphosphonates could cause osteonecrosis of the jaw. The Journal of Oral and Maxillofacial Surgeons printed a similar warning in December 2004, linking a risk of bone tissue death to some cancer patients who received the drugs intravenously and others using the drugs orally.

All patients taking the drugs should consider themselves at risk for jaw rot and should tell their dentists if they take bisphosphonates, endodontistry association president Dr. Marc Balson said in the warning. That’s because experts think the condition is often triggered by dental procedures such tooth extraction.




The pharmaceutical firm Merck, which produces Fosamax, stands by its product, and said reports of people getting jaw degeneration from it are rare. No clinical trials have linked the drug to the problem, the company added in a statement issued in September.

Drug pushes out blood vessels

Dr. David Salmassy is an oral surgeon in Auburn who has seen about 35 cases of jaw osteonecrosis in the last few years. He is highly suspicious of the bone building drugs, he said, and has held seminars to warn area dental doctors about the problem.

“I had a patient lose half of their upper jaw,” Salmassy said. He also thinks the drugs give little bone-building benefit to patients after five years of use, he added.

Endodontist Dr. Sherry Bernadett, of Nevada City, asks all her patients whether they take bisphosphanates before doing any major procedures.

Although she has not personally seen any osteonecrosis cases linked to bone density drugs, “It’s the current hot topic in dentistry,” she said.

“What is happening is that these patients don’t have the ability to heal,” after a dental procedure, Bernadett said.

The drugs help bones regenerate, but in the jaw, it can push out small blood vessels that carry cells to the area, Bernadett said. When those regenerative cells stop coming into the jaw, the bone starts dying.

Bernadett administers a blood test to some patients who have been taking Fosamax to determine their risk level for procedures that could cause the jaw problem.

Sometimes, the patient is asked to stop taking the drug for three months to eliminate the risk, she said. Valentine does the same thing if his patient’s physician gives the OK.

Four of Valentine’s five osteonecrosis patients were successfully treated with antibiotics, but the fifth case did not respond, due to other medical complications. Although he suspects a connection to Fosamax, he also is cautious.

“Researchers don’t have definitive answers yet,” Valentine said.

He also knows of area dentists who are refusing to treat people who are taking Fosamax, but he thinks that is an over-reaction, citing the drug’s ability to help those who need stronger bones.

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To contact Senior Staff Writer Dave Moller, e-mail davem@theunion.com or call 477-4237.

Suspected drugs

The American Association of Endodontists has issued a warning about a possible link to jaw osteonecrosis and the following bisphosphonate drugs used to build stronger bones for cancer and post-menopausal patients.

The trademark names of the drugs are:

• Fosamax • Bonefos

• Ostac • Didronel

• Boniva • Aredia

• Actonel • Skelid

• Zometa

Information from the American

Association of Endodontists


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