Biphosphonates (bone building meds) and Jaw Necrosis – Not Seen in Oral Doses

Lon-term bone building meds intravenously (like Pamidronate) are associated with occasional oseonecrosis of jaw. Now there appears to be some hysteria that this can occur with oral medication. What are the facts?

J Rheumatol. 2009 Mar;36(3):478-90.
Bisphosphonate associated osteonecrosis of the jaw.
Khan AA, Sándor GK, Dore E, Morrison AD, Alsahli M, Amin F, Peters E, Hanley DA, Chaudry SR, Lentle B, Dempster DW, Glorieux FH, Neville AJ, Talwar RM, Clokie CM, Mardini MA, Paul T, Khosla S, Josse RG, Sutherland S, Lam DK, Carmichael RP, Blanas N, Kendler D, Petak S, Ste-Marie LG, Brown J, Evans AW, Rios L, Compston JE. Divisions of Endocrinology and Geriatrics, McMaster University, 331 Sheddon Avenue, Oakville, ON

I don’t usually include such a long author list but felt it important to realize this was not just one person’s opinion.Their findings:

1) “In oncology patients receiving high-dose intravenous BP, ONJ [osteonecrosis jaw] appears to be dependent on the dose and duration of therapy, with an estimated incidence of 1%-12% at 36 months of exposure.”

2)”In osteoporosis patients, it is rare, with an estimated incidence < 1 case per 100,000 person-years of exposure. The incidence of ONJ in the general population is not known. Currently, there is insufficient evidence to confirm a causal link between low-dose BP use in the osteoporosis patient population and ONJ.”

Comment – jaw osteonecrosis is an IV cancer treatment result that can take 3 years to become manifest. With oral biphosphonates like didrocal, actonel and fosamax there is NO definite link – so people relax.

It has been hypothesized that IV induced osteonecrosis can be caused by matrix metalloproteinase 2 (MMP2) gene abnormality.

ref here 

Any comments? – I hear the disease is a miserable one to have.