In the last 10 years, millions of patients have taken a class of drugs that can prevent agonizing broken and deteriorating bones. The drugs once seemed perfectly safe and have transformed life for patients with cancer or osteoporosis.
Joan McDevitt suffered badly after developing osteonecrosis of the jaw.
Multimedia
But recently there have been reports of a serious side effect: death of areas of bone in the jaw.
Everyone agrees that the condition, osteonecrosis of the jaw, is an uncommon complication, but that its true incidence is not known. It is estimated that among the 500,000 American cancer patients who take the drugs because their disease is affecting their bones, 1 to 10 percent may develop the problem.
As for the millions of osteoporosis patients, who take lower doses, the condition seems less common. But no one knows how much less. Some oral surgeons have as many as a couple of dozen cases, but their clinics have become centers to which patients elsewhere are referred. Among people with osteoporosis, only 15 cases of the new ailment have been reported in the medical literature.
So for now, doctors and dentists are perplexed. Firm data are scarce to nonexistent, studies that may provide answers are only about to begin, and medical organizations and drug companies are scrambling to provide guidance, often based only on hunches. Some dentists are refusing to treat patients taking the drugs, fearful that the dental work will induce a case of osteonecrosis, and lawyers are lining up to sue the drugs' makers, saying they failed to give patients adequate warning.
Doctors say worried patients hearing about the ailment are starting to besiege them. The patients want to know whether they should stop taking the drugs, called bisphosphonates. They want to know whether they should shun invasive dental procedures, like tooth extractions and implants, which appear to set off the condition. They want to know whether osteonecrosis of the jaw can be treated and, if so, how likely it is that a person will recover.
Some patients who have not developed osteonecrosis have decided to stop taking the drugs until more is known.
"I'm giving myself a little holiday," said Judy Langley, 63, of Anacortes, Wash., who because of osteoporosis has been taking a bisphosphonate for seven years.
Doctors also say the level of alarm among patients, as well as some physicians and dentists, is itself alarming. "The whole thing has spun out of control," said Dr. Ethel Siris, director of the Toni Stabile Osteoporosis Center at Columbia University.
The Food and Drug Administration is aware of the issue, said Laura Alvey, a spokeswoman, and has required that all bisphosphonate labels disclose the link to osteonecrosis of the jaw. The problem is that patients cannot easily abandon the drugs.
Cancer patients, mostly those with multiple myeloma and breast cancer whose disease has spread to their bones, generally take one of two bisphosphonates, Zometa or the older Aredia, intravenously. The drugs, doctors say, largely prevent excruciating bone pain and fragile bones that break like kindling.
Osteoporosis patients, on the other hand, usually take bisphosphonates as pills, in much lower doses. Those drugs — Fosamax, Actonel and Boniva — reduce the risk of fractures of the spine or hip, injuries that can create a steady downward spiral in pDrug for Bones Is Newly Linked to Jaw Disease
































Heat and energy from the hands
Releases tension from pressure building points on the upper part of the shoulders. Tones, expands, and stimulates the thymus.


Related wiseGEEK articles: 


