With over 190 million prescriptions worldwide, the likelihood of you or someone you know taking a bisphosphonate is impressive. The most popular bisphosphonates are of the oral form and are used to treat osteoporosis. These include Fosamax, Boniva, Actonel, and Zometa. I’m sure you’ve seen a commercial or two on these drugs. With the growing elderly population, these drugs are becoming more and more popular due to their tremendous reduction in fracture rates. But, they have a major side effect as far as oral health. Read on for an in-depth review of what your dentist thinks you should know.
Managing patients taking bisphosphonates is one of the greatest challenges facing the practice of dentistry today. Bisphosphonates are used to treat osteoporosis, Paget’s disease of bone, bone metastases, multiple myeloma, and other disorders that deal with bone fragility. They have excellent results when used to treat osteoporosis, and they have become very popular at controlling this disease. They can be taken orally or intravenously. The majority of bisphosphonates are taken orally for osteoporosis. In the last 5 years, reports have arisen regarding the connection between bisphosphonates and a rare but serious and untreatable side effect known as bisphosphonate related osteonecrosis (dead bone) of the jaws.
Bisphosphonates remain in bone for a long time because they are not metabolized. The half-life of Fosamax is reported to be greater than 10 years, but there are no reports on the half-lives of the IV bisphosphonates. Researchers suggest that the half-life of IV bisphosphonates is just as long or longer than the oral form. This is why just stopping the administration of the drug has little to no affect on the incidence of osteonecrosis. The long term effect on bone is still unknown.
The majority of bisphosphonate related osteonecrosis cases are from tooth extractions, but this can also occur with periodontal surgery, endodontic surgery, and implant placement. However, some cases appear spontaneously with no history of jaw bone manipulation.
No treatment has proven to be successful in treating bisphosphonate induced osteonecrosis, and most patients never get rid of the disease. The primary goal is to eliminate pain, control infection, and minimize progression of bone necrosis. Patients who are at risk for bisphosphonate related osteonecrosis are advised to get educated about the disease process and its relationship to dental treatment.
As the elderly population increases, so does the incidence of osteoporosis, meaning more and more bisphosphonate prescriptions will be written in the near future. According to U.S. Census Bureau projections, a considerable increase in the number of elderly people will occur during the period from 2010 to 2030, after the first baby boomers turn 65 in 2011.
The population of individuals over age 65 in 2030 is projected to be twice as much as in 2000, growing from 35 million to 72 million. The elderly population in 2030 is expected to represent nearly 20 percent of the total U.S. population. The National Osteoporosis Foundation estimates that nearly 44 million people in the United States are at risk for developing osteoporosis, and currently, approximately 10 million Americans suffer from the disease. The use of bisphosphonates in the future will definitely be on the rise, meaning the problem of bisphosphonate related osteonecrosis is only going to become more frequent.
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