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What are the side effects of bisphosphonates?

Bisphosphonates are a class of drugs designed to increase the calcification of bone in osteopenia/porosis patients. You may be familiar with Fosamax as a pill form of the drug, or Zometa as an IV form. There is an association between these drugs and a side effect called Osteonecrosis. Osteo (bone), necrosis (dead) means exactly that- dead bone. Any procedure in dentistry, like an extraction, or periodontal surgery involving the bone can cause this side effect- and it is very hard to treat. Why does this happen? The bisphosphonates seem to inhibit angiogenesis which is the growth of new blood vessels. After a trauma to the bone, if you cannot get re-vascularization, the bone dies. Because the IV form of bisphosphonates in particular have a higher rate of this side effect, it is important that whoever prescribes this rules out any dental disease prior to starting treatment. The 1/2 life of these medications can be years- so once it is in your system, it does not leave for a long time. 

Typically a Rheumatologist or Internist may prescribe bisphosphonates. Please consult with your Dentist BEFORE starting these medications!

David Slovik, MD
Endocrinology Diabetes & Metabolism
While bisphosphonate medications are usually well tolerated, some patients taking bisphosphonates develop severe and sometimes even incapacitating bone, joint, or muscle pain. According to a Food and Drug Administration (FDA) alert, this pain can occur within days, months, or even years after starting a bisphosphonate, and physicians sometimes attribute the pain to other medical conditions, resulting in prolonged discomfort and delayed treatment. While some patients report that the pain disappears completely as soon as they stop taking the medications, others have found that the pain ebbs slowly or only partially.
 
Other reports have surfaced leading to questions about whether bisphosphonates are linked to atypical bone fractures of the femur, damage to the jawbone, or disturbances in heart rhythm. However, some of these effects remain unproven, and problems like these are very uncommon and may occur with longer duration of treatment.
Kent Holtorf, MD
Endocrinology Diabetes & Metabolism
Bisphosphonates such as Fosamax, Acetenol, Reclast and Boniva are widely used to treat osteoporosis. While the short-term use of bisphosphonates has been shown to be beneficial, there is growing concern regarding the long-term consequences with their use. A study of over 13,000 patients by researchers at the University of California School of Dentistry and published in the Journal of the American Dental Association found that 1 out of 25 patients taking Fosamax (alendronate) suffered from osteonecrosis of the jaw (the jaw bone disintegrates) while no cases were found among patients without a history of Fosamax use. There is also shown to be an increase in large bone fracture such as of the femur due to the brittleness of bones caused by these drugs, as well as an increased risk of heart arrhythmias and esophageal cancer.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.