Bisphosphonate Therapy

Abstract

In June of 2006 the American Dental Association Council on Scientific Affairs issued a report on “Dental Management of Patients Receiving Oral Bisphosphonate Therapy – Expert Panel Recommendations.” The full report is available online from the ADA. I would like to point out some relevant statements in this report for ICOI members concerned about this topic. The report states that as of March 2006, the total number of reported cases of possible Bisphosphonate Osteonecrosis (BON) of the jaw in individuals receiving alendronate (Fosamax) is approximately 170 worldwide according to Merck and Co., Inc., approximately 12 in individuals receiving risedronate (Actonel) according to Proctor & Gamble, and approximately 1 individual receiving ibandronate (Boniva) according to Roche. For alendronate, the most commonly prescribed oral bisphosphonate, this translates into a spontaneous BON incidence (or rate at which new cases occur) of approximately 0.7 cases per one hundred thousand person-years exposure. However, to date the true cause and effect relationship between BON and the jaw and oral bisphosphonate has not been established. The ADA panel goes on to make recommendations for patients who are considering dental implant placement. It states, “At this time there is limited data regarding the effects of implant placement on patients taking oral bisphosphonates. Therefore, treatment plans in patients taking bisphosphonates should be carefully considered since implant placement requires the preparation of the osteotomy site. The patient may be at increased risk for BON when extensive implant placement or guided bone regeneration to augment the deficient alveolar ridge prior to implant placement is necessary. Prior to implant placement, the dentist and the patient should discuss the risks, benefits and treatment alternatives, which may include but are not limited to periodontal, endodontic, or non-implant prosthetic treatments. As discussed above, this discussion should be documented and the patient’s written acknowledgement of this discussion and consent for the chosen course of treatment should be obtained. We are currently reviewing our statistics at Montefiore Medical Center with regard to patients who have been taking oral bisphosphonates. We hope to offer the readers of Implant Dentistry a report on this study within the next six months. Early data indicate that we have not seen an increased complication rate or failure rate in the over 50 patients identified and followed who have received implant therapy and who are on oral bisphosphonate. It is clear that there are different degrees of incidence and severity of BON in patients who are on oral bisphosphonates for the treatment of osteoporosis, as compared to those who are on intravenous bisphosphonate for control of metastatic disease. Intravenous bisphosphonates are a contraindication for extraction; periodontal procedures and implant placement.