Bisphosphonates Can Wreak Havoc in the Mouth and Jaws, Oral and Maxillofacial Surgeon Warns

May 05, 2005, 01:00 ET from American Association of Oral and Maxillofacial Surgeons

    ROSEMONT, Ill., May 5 /PRNewswire/ -- Bisphosphonates, a class of drugs
 taken by millions of patients for osteoporosis and bone-related complications
 of metastatic cancer may actually contribute to the onset of
 osteochemonecrosis, or "bis-phossy jaw," a painful, potentially disfiguring
 jaw condition, according to an article published in the May issue of the
 Journal of Oral and Maxillofacial Surgery.
     (Logo:  http://www.newscom.com/cgi-bin/prnh/20050125/CGTU021LOGO )
     While all forms of bisphosphonates, both oral and injectable, may increase
 the risk of bis-phossy jaw, it is the injectable medications, that appear to
 pose the greatest risk, according to John W. Hellstein, DDS, MS, clinical
 professor in the departments of oral pathology, radiology and medicine at the
 University of Iowa. He notes that bisphosphonates, which are often used to
 treat the complications of advanced cancer known as hypercalcemia of
 malignancy, may disrupt the process by which specialized bone cells remove
 diseased bone in the jaw, resulting in serious infection and osteopetrosis, an
 abnormal buildup of dense yet fragile, easily breakable bone.
     Bis-phossy jaw warrants the attention of oral and maxillofacial surgeons
 (OMSs) and other health care professionals in part because bisphosphonate
 therapy has become so prevalent, says Dr. Hellstein.  For example, more than
 300,000 patients worldwide have received the injectable bisphosphonate
 zoledronic acid for hypercalcemia of malignancy.
     Hypercalcemia of malignancy, a potentially fatal condition marked by
 excessive levels of calcium in the blood, occurs when cancer cells metastasize
 (spread) through the blood and lymph systems, becoming lodged in bone.
 Bisphosphonate infusion therapy can help prevent the fractures and pain that
 often result from bone metastases.
     Oral bisphosphonate use for osteoporosis is even more common than
 injectable bisphosphonate use for cancer.  In 2003, the oral bisphosphonate
 alendronate was listed as the 19th most commonly prescribed drug, with 17
 million prescriptions, and risidronate, another oral bisphosphonate, was 72nd
 with 6 million prescriptions.   "With such large numbers, even oral
 bisphosphonates may yet prove to be of clinical concern for oral health care
 providers," Dr. Hellstein says.
     "Because bisphosphonate use is so widespread, we may be witnessing only
 the tip of the iceberg in a possible bis-phossy jaw epidemic," Dr. Hellstein
 warns.
     Recent studies published in the Journal of Oral and Maxillofacial Surgery
 address the relationship between bisphosphonates and osteonecrosis, which
 often results from a decrease in blood supply to specific areas of the bone.
 Osteochemonecrosis differs from osteonecrosis in that it appears to involve a
 bacterial infection rather than a loss of blood flow, with bisphosphonates as
 a key contributing factor.
     The goal of bisphosphonates is to strengthen bone and prevent fractures.
 However, these medications may act somewhat differently on jaw bone,
 particularly in patients with active gum disease and compromised immune
 systems, such as cancer patients who have undergone chemotherapy, Dr.
 Hellstein warns.
     Far from being a static substance, bone is constantly remodeling.  Bone
 cells called osteoblasts create new bone, while bone cells called osteoclasts
 remove old bone.  Normally, these two types of cells work in harmony, a
 balance known as the osteoclast/osteoblast axis.  Bisphosphonates inhibit bone
 removal (resorption) by osteoclasts, thereby supporting the buildup of new
 bone.   While this action may help prevent fractures in the hip, spine and
 other skeletal regions, it may disrupt the osteoclast/osteoblast axis in the
 jaws, impairing osteoclasts' ability to remove, and thus repair or contain,
 'diseased' bone.
     This impairment then causes osteoblasts to "overbuild" or "wall off"
 diseased bone.   As osteoblasts build new bone, the failure of osteoclasts to
 remove contaminated bone interferes with the development of the necessary
 structure, or 'scaffolding,' on which to lay down healthy bone.
     Dr. Hellstein urges the development of protocols to better predict
 patients at risk for bis-phossy jaw and preventive measures to decrease the
 incidence of the disease.  "We will need much more research to see what
 population groups or oral factors are the best risk predictors of bis-phossy
 jaw," he says.  "There is no doubt that bisphosphonate therapy will continue
 to show substantial clinical benefits and grow in use.  We need to discover
 the ideal dosage, delivery route, and bisphosphonate for each patient
 category."
     The American Association of Oral and Maxillofacial Surgeons (AAOMS), the
 professional organization representing more than 7,000 oral and maxillofacial
 surgeons in the United States, supports its members' ability to practice their
 specialty through education, research, and advocacy. AAOMS members comply with
 rigorous continuing education requirements and submit to periodic office
 examinations, ensuring the public that all office procedures and personnel
 meet stringent national standards.
 
 

SOURCE American Association of Oral and Maxillofacial Surgeons
    ROSEMONT, Ill., May 5 /PRNewswire/ -- Bisphosphonates, a class of drugs
 taken by millions of patients for osteoporosis and bone-related complications
 of metastatic cancer may actually contribute to the onset of
 osteochemonecrosis, or "bis-phossy jaw," a painful, potentially disfiguring
 jaw condition, according to an article published in the May issue of the
 Journal of Oral and Maxillofacial Surgery.
     (Logo:  http://www.newscom.com/cgi-bin/prnh/20050125/CGTU021LOGO )
     While all forms of bisphosphonates, both oral and injectable, may increase
 the risk of bis-phossy jaw, it is the injectable medications, that appear to
 pose the greatest risk, according to John W. Hellstein, DDS, MS, clinical
 professor in the departments of oral pathology, radiology and medicine at the
 University of Iowa. He notes that bisphosphonates, which are often used to
 treat the complications of advanced cancer known as hypercalcemia of
 malignancy, may disrupt the process by which specialized bone cells remove
 diseased bone in the jaw, resulting in serious infection and osteopetrosis, an
 abnormal buildup of dense yet fragile, easily breakable bone.
     Bis-phossy jaw warrants the attention of oral and maxillofacial surgeons
 (OMSs) and other health care professionals in part because bisphosphonate
 therapy has become so prevalent, says Dr. Hellstein.  For example, more than
 300,000 patients worldwide have received the injectable bisphosphonate
 zoledronic acid for hypercalcemia of malignancy.
     Hypercalcemia of malignancy, a potentially fatal condition marked by
 excessive levels of calcium in the blood, occurs when cancer cells metastasize
 (spread) through the blood and lymph systems, becoming lodged in bone.
 Bisphosphonate infusion therapy can help prevent the fractures and pain that
 often result from bone metastases.
     Oral bisphosphonate use for osteoporosis is even more common than
 injectable bisphosphonate use for cancer.  In 2003, the oral bisphosphonate
 alendronate was listed as the 19th most commonly prescribed drug, with 17
 million prescriptions, and risidronate, another oral bisphosphonate, was 72nd
 with 6 million prescriptions.   "With such large numbers, even oral
 bisphosphonates may yet prove to be of clinical concern for oral health care
 providers," Dr. Hellstein says.
     "Because bisphosphonate use is so widespread, we may be witnessing only
 the tip of the iceberg in a possible bis-phossy jaw epidemic," Dr. Hellstein
 warns.
     Recent studies published in the Journal of Oral and Maxillofacial Surgery
 address the relationship between bisphosphonates and osteonecrosis, which
 often results from a decrease in blood supply to specific areas of the bone.
 Osteochemonecrosis differs from osteonecrosis in that it appears to involve a
 bacterial infection rather than a loss of blood flow, with bisphosphonates as
 a key contributing factor.
     The goal of bisphosphonates is to strengthen bone and prevent fractures.
 However, these medications may act somewhat differently on jaw bone,
 particularly in patients with active gum disease and compromised immune
 systems, such as cancer patients who have undergone chemotherapy, Dr.
 Hellstein warns.
     Far from being a static substance, bone is constantly remodeling.  Bone
 cells called osteoblasts create new bone, while bone cells called osteoclasts
 remove old bone.  Normally, these two types of cells work in harmony, a
 balance known as the osteoclast/osteoblast axis.  Bisphosphonates inhibit bone
 removal (resorption) by osteoclasts, thereby supporting the buildup of new
 bone.   While this action may help prevent fractures in the hip, spine and
 other skeletal regions, it may disrupt the osteoclast/osteoblast axis in the
 jaws, impairing osteoclasts' ability to remove, and thus repair or contain,
 'diseased' bone.
     This impairment then causes osteoblasts to "overbuild" or "wall off"
 diseased bone.   As osteoblasts build new bone, the failure of osteoclasts to
 remove contaminated bone interferes with the development of the necessary
 structure, or 'scaffolding,' on which to lay down healthy bone.
     Dr. Hellstein urges the development of protocols to better predict
 patients at risk for bis-phossy jaw and preventive measures to decrease the
 incidence of the disease.  "We will need much more research to see what
 population groups or oral factors are the best risk predictors of bis-phossy
 jaw," he says.  "There is no doubt that bisphosphonate therapy will continue
 to show substantial clinical benefits and grow in use.  We need to discover
 the ideal dosage, delivery route, and bisphosphonate for each patient
 category."
     The American Association of Oral and Maxillofacial Surgeons (AAOMS), the
 professional organization representing more than 7,000 oral and maxillofacial
 surgeons in the United States, supports its members' ability to practice their
 specialty through education, research, and advocacy. AAOMS members comply with
 rigorous continuing education requirements and submit to periodic office
 examinations, ensuring the public that all office procedures and personnel
 meet stringent national standards.
 
 SOURCE  American Association of Oral and Maxillofacial Surgeons