Abstract
While large clinical trials have shown rare adverse side effects in post-menopausal women taking uninterrupted oral bisphosphonates (BPs), there is mounting evidence that longer-term treatment may be associated with osteonecrosis of the jaw (ONJ). There is a paucity of information regarding the causal relationship between extended oral BP treatment and ONJ, and the safety of non-surgical therapy of apical lesions and length of treatment in women on long-term BPs. We describe a post-menopausal woman on long-term oral BPs who developed ONJ without any contributory risk factors. Quantitative data was gathered through review of the patient's medical record. Qualitative data was gathered from face-to-face interviews with patient and clinician. Analysis of the data revealed the patient did not feel it was important to report her use of BPs. Given the wide usage of antiresorptives dental clinicians should manage all post-menopausal women with the assumption they currently or have recently been treated with BPs. There is a need for a collaborative effort by medical and dental practitioners to reduce risk of ONJ, ensure proper BP dosing and length of treatment, identify contributory risk factors, and explore alternate modalities, such as Ca(OH)2 multi-visit palliative pulpectomy, to avert ONJ and improve treatment outcomes.
Highlights
2500 cases of osteonecrosis of the jaw (ONJ) have been reported in the literature since 2003 [1]
30 million prescriptions for oral bisphosphonates are written in the U.S alone [2]
No causal relationship has been established between chronic, long-term oral BP therapy and ONJ, but there is an urgent need to close the knowledge gap to allow clinicians to identify the condition, determine the cause, prevent bone necrosis, and identify patients at risk
Summary
2500 cases of osteonecrosis of the jaw (ONJ) have been reported in the literature since 2003 [1]. 30 million prescriptions for oral bisphosphonates are written in the U.S alone [2]. No causal relationship has been established between chronic, long-term oral BP therapy and ONJ, but there is an urgent need to close the knowledge gap to allow clinicians to identify the condition, determine the cause, prevent bone necrosis, and identify patients at risk. The Federal Drug Administration (FDA) in October 2010 added a warning label regarding possible risks of atypical femur fracture with the use of Fosamax (Merck) and Actonel (Procter & Gamble Pharmaceuticals). A task force set up by the American Society of Bone and Mineral Research in September 2010 found 94% of 310 atypical femur fractures were associated with oral bisphosphonate therapy >5 years [5,6]
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