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Bisphosphonates, Dental Procedures Not a Good Combo for Some Cancer Patients

Sep 13, 2012 | Parker Waichman LLP

New research suggests that people taking bisphosphonate drugs in the treatment of cancers multiple myeloma or Waldenstrom's macroglobulinemia are more likely to suffer osteonecrosis of the jaw (ONJ) after they undergo a dental procedure.

 According to a report on a new study from scientists at Ospedale Nuovo Regina Margherita in Rome, Italy, nearly 80 percent of the cases of ONJ observed as part of the study were among people who had recently undergone a dental surgery, mostly tooth extractions, and had been taking bisphosphonate drugs.

 How much of a bisphosphonate drug a person took - their cumulative dose - played a large factor in determining who had a predisposition to developing ONJ, the study found.

 Patients suffering from these malignant cancers often take bisphosphonate drugs like Aredia and Zometa to prevent bone fractures caused by metastases. 

 The study was able to identify a total of 55 patients who had developed ONJ while taking bisphosphonate drugs in the treatment of these diseases and all but one had undergone a dental surgery. 

Rather than wantonly prescribing bisphosphonate drugs, the study authors determined that a preventative dental exam be done prior to a prescription being written for either of the drugs Aredia or Zometa. Also, prescribing these drugs for longer than a period of one to two years is not recommended.

The report details the findings of the study, which appear in the most recent edition of Blood Cancer Journal: “Examination of patient treatment history showed that 10 (18%) patients developed ONJ within 12 months of starting bisphosphonate therapy, 16 (29%) between 12 and 24 months, 10 (18%) between 24 and 36 months, four (7%) after 36 to 48 months, and 15 patients (27%) after 48 months.”

 Treatment of the ONJ cases with antibiotics and other means helped 20 of the 55 patients completely recover and another 21 saw some improvements. Nine people saw no improvement in their ONJ and another three had their condition worsen after treatment. People who had been taking lower doses of the bisphosphonate drugs were more likely to respond well to treatments.

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