Bone-boosting drug that could wreck your jaw
THOUSANDS of women who take drugs for the bonethinning disease osteoporosis are at risk of developing a painful and disfiguring jaw condition. Osteonecrosis of the jaw (ONJ) affects some patients who have a tooth removed after they have been prescribed bisphosphonates, the most commonly used drugs for osteoporosis.
Bisphosphonates are a very effective treatment to prevent bone-thinning and reduce the risk of fractures, but they change the way bone behaves and the effects can be so severe that, in rare cases, women even need reconstructive surgery afterwards.
ONJ affects one in every 200 patients prescribed bisphosphonates who then have a tooth removed. Yet a ‘worrying number’ of GPs are not aware of the risks, says Carrie Newlands, a consultant oral surgeon who has treated several cases of ONJ at the Royal Surrey Hospital.
‘The first symptom is a nonhealing socket in the gum following a tooth extraction, leaving the bare bone exposed and at risk of infection,’ she says.
‘Sometimes the socket never heals and part of the jawbone has to be removed, with the need for major reconstructive surgery.’
More cases will develop, she warns, if increasing numbers of menopausal women are prescribed bisphosphonates as the population ages. A study published last year by the Journal Of Bone And Mineral Research suggests incidence of ONJ may climb in patients who have had years of exposure to the drug.
The most frequently prescribed bisphosphonate drug is alendronic acid, marketed as Fosamax. Nearly 700,000 patients in the UK alone take it orally.
Its maker, Merck, has already settled a $27.7million lawsuit in the US in 2013 brought by 1,200 patients, admitting it did not know how long patients should stay on the medication. There are no guidelines on how long women should take Fosamax, although Merck does recommend a regular medication review and a ‘drug holiday’ after five years.
The UK Medicines and Healthcare products Regulated Agency (MHRA) has urged all prescribers to update their care standards.
Imogen Faux’s GP failed to alert her to possible side effects from bisphosphonate drugs when she was diagnosed with osteoporosis in 2001. The 61-year-old was prescribed it once a week and is now concerned about her risk of ONJ after discovering a fractured tooth that must be removed.
She has stopped taking the medication as a temporary measure and insisted on a bone-density scan to show whether it is safe to have a break from the drug or whether her fracture risk is so high that she must carry on taking it.
‘I feel very upset that my GP surgery did not pick up the risk when it was first identified in 2003, when I had been taking the medication for only a couple of years,’ Ms Faux says. ‘My dentist was well aware of the risk of ONJ, but my GP knew nothing about it when I asked how long bisphosphonates stayed in the system.’
The Royal College of General Practitioners says it is ‘good practice for any prescribing healthcare professionals’ to warn patients of the risks so they can tell their dentist they are taking bisphosphonates.
Private dentists urge a more conservative approach. Dr Julian Webber, founder of the Harley Street Centre for Endodontics and the Saving Teeth Awareness Campaign, says: ‘Extraction must be avoided at all costs in patients on bisphosphonates; root canal treatment by a specialist is recommended.’
Experts say that the risk of developing ONJ is at least 100 times less than suffering a fracture.