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    Low Risk of Jaw Problems With Oral Osteoporosis Drugs

    Study Shows Lower Risk of Jaw Osteonecrosis With Oral Bisphosphonates Than With IV Drugs

    Oral Osteoporosis Drugs vs. IV Drugs continued...

    "Some of them took IV bisphosphonates; others took the oral," Tawil says. Of those on the drugs, 213,364 were on oral and 2,321 were on IV.

    Next, they compared these to a group of 423,845 patients who did not take any bisphosphonates.

    "The incidence of having necrosis of the jaw was very low -- about one per 1,000 for those who took oral [bisphosphonates]," Tawil says.

    In the intravenous group, six of every 1,000 developed osteonecrosis of the jaw.

    The risk of the jaw problem while on oral bisphosphonates, Tawil says, was similar to those not on the drugs. In non-users, he says, the risk was about 0.9, or less than one in 1,000.

    The findings echo those of some previous studies finding low risk with the oral drugs, Jeffcoat says, but their research population is larger.

    "The benefit outweighs the risk in treating osteoporosis with oral drugs," she says. Jeffcoat reports receiving research funding from Merck in 2004. Merck makes the oral bisphosphonate Fosamax.

    Second Opinion

    John Kalmar, DMD, professor of oral and maxillofacial pathology at Ohio State University, Columbus, reviewed the study abstract for WebMD. He agrees with some findings but is highly skeptical of others.

    ''I agree that the risk of osteonecrosis of the jaw is less with oral than for IV [bisphosphonates]," he says. "At this point everyone would agree."

    But, he says, to equate the risk of those on oral drugs with persons not taking them, "I take great exception to."

    "All studies to date have shown that even though the risk is a small increase it is still a measurable increase," Kalmar says.

    Another potential problem, Kalmar tells WebMD, involves coding. Recently, a more specific medical code has come into use for osteonecrosis of the jaw. But in a database as large as the one studied by Jeffcoat and Tawil, which goes back to 2000, he says it is likely some cases of osteonecrosis were coded incorrectly.

    It's no surprise to Kalmar that the study involving 516 patients on the drugs revealed no cases, as that number of patients is probably too small.

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