[PHNUTR-L] Bisphosphonates -- Both IV and Oral -- Can Cause Problems in Jaw

[Kathrynne Holden, MS, RD]

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Colleagues, the following is FYI and does not necessarily reflect my own
opinion. I have no further knowledge of the topic.
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Bisphosphonates Can Cause Problems in Jaw

By Rachael Myers Lowe, cancerpage.com
http://www.cancerpage.com/news/article.asp?id=8122

(March 15, 2005) - Cancer patients given drugs called bisphosphonates to 
control hypercalcemia – too much calcium in the blood – or the growth of 
bone metastases can develop bone death in the jaw the FDA warns.

Makers of several bisphosphonates have added advisories to their drugs, 
warning doctors and patients of the increased risk of osteonecrosis of 
the jaw (ONJ), particularly in patients undergoing a dental procedure 
while taking an intravenous bisphosphonate such as Aredia or Zometa and 
other cancer treatments.

These drugs are often given to cancer patients with metastases to the 
bone as standard therapy.

Cancer that has spread to the bone upsets the delicate balance of 
healthy bone growth and regeneration so that often, bone is destroyed 
faster than it can be replaced.  Bisphosphonates slow down unnaturally 
speeded up bone destruction - called bone resorption.

Although researchers don’t know why, a small number patients taking 
bisphosphonates develop osteonecrosis of the jaw, a condition in which 
the bone tissue in the jaw fails to heal after a minor trauma such as a 
tooth extraction causing the bone to be exposed.  Symptoms include jaw 
pain or inflammation, gums that don’t heal, loosening teeth, or a 
feeling of numbness or heaviness in the jaw.

The condition sometimes can be treated with antibiotics and mouth 
rinses. Because surgery can make the condition worse, it’s avoided 
although sometimes it’s necessary to remove dead tissue.

A background sheet from the FDA’s Oncologic Drugs Advisory Committee 
points out that the research suggests the risk is highest for people 
given bisphosphonates intravenously. Some patients take oral 
bisphosphonates, such as Fosamax, for osteoporosis.  The FDA 
acknowledges that there have been reports of ONJ in oral bisphosphonate 
users but writes: “There have been fewer reports [ …] and risk-benefit 
considerations are different for patients with malignant as opposed to 
benign disease.”

The new drug warning labels recommend patients delay invasive dental 
procedures such as tooth extraction.

SOURCES:

     * FDA Oncologic Drugs Advisory Committee background sheet, March 4, 
2005.
     * Novartis "Dear Doctor" letter, September 24, 2004.
http://www.cancerpage.com/news/article.asp?id=8122
-- 
Kathrynne Holden, MS, RD < fivestar at nutritionucanlivewith.com >
"Ask the Parkinson Dietitian"  http://www.parkinson.org/
"Eat well, stay well with Parkinson's disease"
"Parkinson's disease: Guidelines for Medical Nutrition Therapy"
http://www.nutritionucanlivewith.com/