The latest study from the Journal of the National Cancer Institute has confirmed that use of IV bisphosphonate drugs Aredia (pamidronate) and Zometa (zoledronic acid) in cancer patients substantially increases the risks of osteonecrosis of the jaw. A number of small studies have previously noted an increased risk, but this was the first study to analyze a larger number of patients.
Investigators reviewed Medicare claims data for 14,349 patients given IV bisphosphonates versus more than 28,000 cancer patients who had not received the drugs from 1995 through 2003 who were matched by age, sex, risk factors for the development of jaw osteonecrosis and other factors. The Medicare data indicated that only 170 patients received bisphosphonate therapy in 1995, whereas 5,348 patients received this drug therapy in 2003. Patients who received Aredia or Zometa through IV had a 5.5% change of developing inflammation or osteomyelitis of their jaw versus a risk of a mere .3% in cancer patients not receiving these drugs.
Osteonecrosis of the jaw causes severe infections, facial swelling, and tooth loss resulting in the need for long-term antibiotic therapy, surgery, disability, and pain and suffering. Patients undergoing dental procedures and those who are simultaneously using corticosteroids are at particular risk for developing this condition, and should inform their physicians regarding their use of these drugs prior to any tooth extractions, dental implants, etc. Symptoms of jaw osteonecrosis include exposed bone, pain and swelling in the jaw, infection, altered sensation, and numbness. The jaw is particularly susceptible to this condition since it absorbs ten times more of the bisphosphonate drug than other bones in the body. Unfortunately, bisphosphonates accumulate in the bones and may remain in the bony tissues for perhaps up to twelve years after discontinuation. Other oral forms of bisphosphonates that have been linked to jaw osteonecrosis include Fosamax, Actonel, Boniva, Bonefos, Skelid, and Didronel.
For more information on this subject matter, please refer to the section on Drugs, Medical Devices, and Implants.