Osteoporosis Medications

Osteoporosis is a serious skeletal disorder that weakens bones and increases the risk of developing fractures. It affects about 10 million Americans, 8 million of them women. Another 34 million are at risk of developing osteoporosis. This disorder affects more women than cancer, heart disease and stroke combined. Many patients are treated with a group of prescription drugs called "oral bisphosphonates." Examples include alendronate (Fosamax, Merck & Co., Whitehouse Station, N.J.), risedronate (Actonel, Procter & Gamble, Cincinnati, O.H.) and ibandronate (Boniva, Roche, Nutley, N.J.).

Osteonecrosis of the Jaws

Jaw complications linked to the use of bisphosphonates are a growing concern. Bone is a living tissue with living cells and a blood supply. Osteonecrosis means death of bone which can occur from loss of blood supply or from a problem with the bone's ability to regenerate. Bisphosphonates have been associated with osteonecrosis of the jaws (ONJ), an uncommon but potentially serious condition that can cause severe destruction of the bones of the jaws. News reports have alarmed and confused many patients who receive these drugs to treat or prevent osteoporosis. Most cases of ONJ have been seen in patients with cancer who receive treatment with intravenous bisphosphonates, which absorb differently from oral bisphosphonates. The true risk posed by oral bisphosphonates remains uncertain. While most researchers agree the risk of ONJ appears to be very small (1 in 100,000), a new study reported in the January 2009 issue of the Journal of the American Dental Association (ADA) suggests even oral bisphosphonates can be a serious problem for some patients.

Osteoporosis and Bone Fracture

The risks of osteoporosis are serious, especially the development of bone fractures. Fractures of the spinal column and hip are the most common osteoporosis problems, and hip fractures can be life threatening. The National Osteoporosis Foundation reports that an average of 24 percent of patients 50 years and older with hip fractures die within one year of their injury. One in five patients with a hip fracture requires extended nursing home care. Six months after experiencing a hip fracture, only 15 percent of patients are able to walk across a room without help. A woman's risk of experiencing a hip fracture is equal to her combined risk of developing breast and ovarian cancers.

Talk to Your Physician

It is estimated that oral bisphosphonates may reduce by 40 percent the risk of experiencing a hip fracture in patients with osteoporosis. Thus it is possible these drugs could prevent more than 100,000 hip fractures and tens of thousands of deaths each year. Given the risks associated with osteoporosis and the proven benefits of oral bisphosphonate therapy, you should never stop taking these medications before discussing the matter fully with your physician. Given the significant benefits of these medications for osteoporosis, your physician may recommend that you continue receiving oral bisphosphonate treatment despite the slight risk of developing ONJ.

Talk to Your Dentist

Always discuss your medications with your dentist. It is helpful to always carry a written copy of all medications you are taking, and a list of medications you have taken in the past. This should also include a list of any medications that have caused an allergic reaction. If your physician has prescribed oral bisphosphonates for you, it is important to tell your dentist. Some dental procedures, such as extractions, may increase your risk of developing ONJ. The ADA has published treatment guidelines for patients receiving bisphosphonate therapy. Medical and dental researchers continue to study ways to prevent and treat ONJ and ensure the safest possible care for patients taking bisphosphonates. While neither your physician nor your dentist can eliminate the possibility of developing ONJ, regular dental visits and maintaining excellent oral hygiene at home are essential in helping to avoid this significant complication related to osteoporosis medications.

Additional information is available on the following web page: http://www.ada.org/prof/resources/topics/osteonecrosis.asp.