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Fosamax: Higher Risk of Jawbone Death?

After Tooth Extraction, Fosamax Patients Have 4% Risk of Jaw Osteonecrosis


In their study, Sedghizadeh and colleagues combed through their records and identified 208 patients who took Fosamax. Sixty-six of these patients had teeth extracted; nine of these patients developed jaw osteonecrosis -- four at the site of the extraction and five after denture-related ulceration.

Among 4,384 tooth extraction patients not on Fosamax, none developed jaw osteonecrosis.

However, patients who developed osteonecrosis had other factors, including chemotherapy, type 2 diabetes, high blood pressure, high cholesterol, and steroid therapy. Some of these conditions are risk factors for osteonecrosis.

Nevertheless, Sedghizadeh notes that USC now warns all dental patients taking Fosamax and other bisphosphonates that "you may be at risk of developing osteonecrosis (bone death) of the jaw, and certain dental treatments may increase that risk."

Merck notes in a statement that the Sedghizadeh study contains methodological flaws and that the findings cannot be used to reach "valid scientific conclusions regarding the prevalence of osteonecrosis of the jaw" in patients taking Fosamax.

"Data from randomized, prospective clinical trials are the gold standard and are more reliable than data from studies like the [Sedghizadeh study]," the statement reads. "In controlled clinical trials involving more than 17,000 patients, contributing as much as 10 years' data with [Fosamax], there have been no reports of osteonecrosis of the jaw. This includes approximately 3,000 osteoporosis patients taking [Fosamax] for three to five years and approximately 800 patients taking [Fosamax] for eight to 10 years."

Sedghizadeh and colleagues call for other institutions to go through their own records to establish whether patients on Fosamax and other bisphosphonates have a higher risk of jawbone death after dental procedures.

The Sedghizadeh study appears in the January issue of the Journal of the American Dental Association.

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