Fossy jaw risk lower with oral meds

Research published in the Journal of the American Dental Association has released new data on the risk of jaw osteonecrosis associated with bisphosphonates.

The study found intravenous bisphosphonates (IBS) strongly increased the risk of adverse jaw outcomes. Oral bisphosphonates, however, appeared to decrease the risk.

IBS are typically used to treat bone metastasis or severe cases of osteoarthritis.

"This is good news for the roughly 3 million Americans who take Fosamax, Actonel, Boniva or similar osteoporosis meds orally," said senior author Dr Athanasios Zavras, from the Department of Oral Health Policy & Epidemiology, Harvard School of Dental Medicine in Boston.

In 2003, case reports linked intravenous bisphosphonate treatment with osteonecrosis of the jaw. Subsequent studies confirmed this association. Concern was limited to intravenous bisphosphonates until May 2005, when the Journal of Oral and Maxillofacial Surgery published a report on 63 patients with osteonecrosis of the jaw. Seven of those patients had taken oral bisphosphonate forms.

Zavras and colleagues analysed medical claims from 714,217 patients with osteoporosis or cancer to determine the effect that bisphosphonate use had on inflammatory conditions of the jaw, major jaw surgery because of necrosis, or on jaw surgery for a malignancy.

The results showed that intravenous bisphosphonate use increased the risk of inflammatory necrosis of the jaw by 4.0-fold in patients with osteoporosis and by 4.5-fold in those with cancer. Among patients with either condition who required surgery for necrosis, the risk increased by 7.8-fold and 6.8-fold, respectively.

By contrast, oral bisphosphonate use cut the risk of inflammatory necrosis of the jaw by 35% in patients with osteoporosis. No significant effects of oral bisphosphonates were associated with surgery for necrosis, or for any of the adverse jaw outcomes in cancer patients.

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