Osteoporosis meds can damage jaw
Dear Dr. Roach: I am taking Fosamax for osteoporosis. One of the side effects is osteonecrosis of the jaw. Can it happen with routine dental cleanings, fillings?
G.D.
Answer: Osteonecrosis of the jaw is a serious condition involving poor blood flow that results in death of the bone cells in the jaw. It may affect either the top portion (maxilla) or bottom (mandible).
ONJ can happen in people who aren’t taking medications, especially people with certain conditions such as having had radiation to the jaw or sickle cell disease, but it is often associated with some kinds of medications used to treat osteoporosis, such as the alendronate (Fosamax) you take.
Dental extractions and implants increase risk of ONJ. Regular dental care, such as cleanings, probably decreases the risk of ONJ by improving dental health.
ONJ is not common in people taking oral medications such as Fosamax. The estimate is that for a person taking an oral bisphosphonate for five years, about 1 in 20,000 people will develop ONJ.
Dear Dr. Roach:
I’m in my 60s and am noticing many people — mostly women — with crossed toes. It looks painful! Why don’t their doctors send them to a podiatrist? Why do people just let this go? It can’t be money, because many of the folks who I see have plenty of that! Could you enlighten me?
C.D.
Answer: There are many common deformities of the toe, including crossover toe, hammertoe, bunions and claw toe. Both men and women get these, but women may be more likely to get them if they are putting their feet into pointy-toed, high-heeled shoes, which make a person’s feet more prone to tendon damage.
I’ll bet many of the people you see have been to a podiatrist. But not every problem of the foot or toes needs surgery in order to be fixed. Orthotics, “buddy taping” a toe into place and using toe spacers all can help this condition.
More advanced cases need further treatment, sometimes including physical therapy or injection. Surgery is considered only when less invasive treatments have failed.