Bisphosphonates

Bisphosphonates are a class of drugs that prevent the loss of bone mass and are used to treat osteoporosis and similar diseases. This group of drugs current include Fosamax, Boniva, Aredia, Actonel and Zometa among others. Bisphosphonates have been associated with osteonecrosis of the jaw (ONJ) with the mandible twice as frequently affected as the maxilla and most cases occurring following high-dose intravenous administration used for some cancer patients. Some 60% of cases of ONJ are preceded by a dental surgical procedure (that involve the bone) and it has been suggested that initiating bisphosphonate treatment should be postponed until after any dental work to eliminate potential sites of infection.

It is important to discuss your bisphosphonate history with us. Oral bisphosphonate use has a much lower risk of ONJ than does IV. Additionally there seems to be a correlation with the amount of time a patient has been taking it. The risk of ONJ is minimal from 0-3 years greater by about 30% for 3-5 years and 50% higher with 5-7 years. Additionally there seems to be some benefit from taking a “bisphosphonate holiday” for several months before oral surgery.

For those patients recently or currently that are requiring oral surgery or dental implants, there is a test know as a CTx Test, is short for: serum C-terminal telopeptide test. It is a medical blood test that is used to assess the risk of oral bisphosphonate-induced osteonecrosis of the jaws and guide treatment decisions. According to Marx ( J Oral Maxillofac Surg. 2007 Dec;65(12):2397-410.): A stratification of relative risk was seen as CTX values less than 100 pg/mL representing high risk, CTX values between 100 pg/mL and 150 pg/mL representing moderate risk, and CTX values above 150 pg/mL representing minimal risk.

Treatment of ONJ is slow and unpredictable. Conservative management is recommended and includes antibiotics, antibacterial mouthwashes, limited debridement of the site and analgesics.