X-rays help predict permanent bone damage from bisphosphonates
Breast cancer patients, individuals at risk for
osteoporosis and those undergoing certain types of bone cancer therapies
often take drugs containing bisphosphonates.
These drugs have been found
to place people at risk for developing osteonecrosis of the jaws (a
rotting of the jaw bones). Dentists, as well as oncologists, are now
using X-rays to detect "ghost sockets" in patients that take these drugs
and when these sockets are found, it signals that the jawbone is not
healing the right way. Early detection of these ghost sockets can help
the patient avoid permanent damage to their jawbone, according to an
article in the March/April 2009 issue of General Dentistry, the Academy
of General Dentistry's (AGD) clinical, peer-reviewed journal.
A ghost socket occurs when the jawbone is not healing and repairing
itself the right way. "The good news is that even though these ghost
sockets may occur, by using radiographic techniques we can see that the
soft tissue above these sockets can still heal," according to Kishore
Shetty, DDS, MS, MRCS, lead author of the report. Dr. Shetty states
these findings are important news to learn about because early
prevention and detection can halt permanent damage from happening to a
patient's jawbone.
In 2006, about 191 million prescriptions of oral bisphosphonates
worldwide were written. The National Osteoporosis Foundation estimates
that nearly 44 million people in the United States are at risk for
developing osteoporosis. Currently, approximately 10 million Americans
suffer from the disease.
Bisphosphonates are a family of drugs used to prevent and treat
osteoporosis, multiple myeloma, Paget's disease (bone cancers), and bone
metastasis from other cancers. These drugs can bond to bone surfaces and
prevent osteoclasts (cells that break down bone) from doing their job.
Other cells are still working trying to form bone, but it may turn out
to be less healthy bone leading to the ghost-like appearance on X-rays.
"Healthy bones can easily regenerate," says Dr. Shetty. "But, because
jawbones have rapid cell turnover, they can fail to heal properly in
patients taking any of the bisphosphonate drugs. It's very important for
patients to know about complications from dental surgery or extractions.
Since these drugs linger in the bone indefinitely, they may upset the
cell balance in how the jaws regenerate and remove unhealthy bone."
According to AGD spokesperson Carolyn Taggart-Burns, DDS, FAGD, patients
who are taking bisphosphonates should inform their dentist to prevent
complications from dental surgical procedures.
"Widespread use of bisphosphonates to prevent or treat early
osteoporosis in relatively young women and the likelihood of long-term
use is a cause for concern," says Dr. Taggart-Burns.
Drs. Shetty and Taggart-Burns agree that, "how bisphosphonates interfere
with healing after dental surgery is still unclear and further research
will be needed. It is imperative that the public understands there is no
present treatment or cure for this problem."
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