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Osteoporosis Health Center

Fosamax: Higher Risk of Jawbone Death?

After Tooth Extraction, Fosamax Patients Have 4% Risk of Jaw Osteonecrosis
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Jan. 2, 2009 -- After having teeth pulled, 4% of patients in a study who were taking Fosamax developed a dangerous condition called osteonecrosis of the jaw, USC researchers report. None of the tooth extraction patients not taking Fosamax developed osteonecrosis.

The condition, sometimes called jawbone death, occurs when bone in the jaw fails to heal after a minor trauma. It results in pain, swelling, infection, and exposed bone.

Merck says the study has numerous flaws. But study researchers Parish P. Sedghizadeh, DDS, and colleagues say Fosamax and other bisphosphonate drugs may be riskier than previously thought.

"Here at the USC School of Dentistry, we're getting two or three new patients a week that have bisphosphonate-related osteonecrosis of the jaw -- and I know we're not the only ones seeing it," Sedghizadeh says in a news release.

Just last month, an expert panel for the American Dental Association concluded that the risk of jaw osteonecrosis "apparently remains low" for people taking bisphosphonates. In addition to Fosamax, other oral bisphosphonate drugs include Zometa, Aredia, and Actonel, and Boniva.

Even so, it's not the first time questions have been raised about bisphosphonates and jawbone death. A 2005 paper in the Journal of the American Dental Association reviewed the risk, as did a 2005 study in the Journal of Endodontics and a 2006 editorial in the New England Journal of Medicine.

Injection versions of the drugs appear to carry a higher risk. The risk of osteonecrosis is generally thought to be quite low for oral bisphosphonates.

"We've been told that the risk with oral bisphosphonates is negligible, but 4% is not negligible," Sedghizadeh says.

The Fosamax label and the labels of other bisphosphonate drugs note that jaw osteonecrosis has been reported in patients taking bisphosphonates, including some patients taking the drugs for postmenopausal osteoporosis. But jaw osteonecrosis patient Lydia Macwilliams says nobody warned her during her three years of Fosamax use.

"My doctor who prescribed Fosamax didn't tell me about any possible problems with my teeth," Macwilliams, one of Sedghizadeh's patients, says in a USC news release.

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