A recent article discusses the various relationships between osteoporosis, osteonecrosis, and bisphosphonate medications.

Osteoporosis (Paget’s Disease)

Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild stresses such as bending over or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist, or spine.

Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn’t keep up with the loss of old bone.

Osteoporosis affects those of all races, but white and Asian females, especially older females who are past menopause, are at highest risk. Medications, healthy diet, and weight-bearing exercise can help prevent bone loss or strengthen already weak bones.

Symptoms:

There typically are no symptoms in the early stages of bone loss. But once your bones have been weakened by osteoporosis, you might have signs and symptoms that include:

• Back pain, caused by a fractured or collapsed vertebra
• Loss of height over time
• A stooped posture
• A bone that breaks much more easily than expected

Osteonecrosis

Avascular necrosis, which is also known as osteonecrosis, is a rare disease characterized by reduced blood flow to bones in the joints, leading to bone tissue death. Avascular necrosis is associated with long-term use of high-dose steroid medications and excessive alcohol intake.

Osteonecrosis of the Jaw (ONJ)

Osteonecrosis of the jaw is a rare condition where the bone in the jaw dies. It is a very uncommon condition but is one that is very serious and can cause incredible destruction to the jawbone.

Symptoms of this rare condition include, but are not limited to, pain, swelling, infections of the gums or jaw, gums that are not able to heal, loose teeth, numbness or a heavy feeling within the jaw, drainage, and exposed bone.

Since the conditions is so rare, researchers are currently unable to predict who will develop it. The condition is diagnosed through X-rays or through testing for infection from microbial cultures.

Patients are treated with antibiotics, oral rinses, and removable mouth appliances. In some cases, patients may require minor dental work (to remove damaged or injured tissue and reduce any sharp edges of the damaged bone). Typically, surgery is avoided with this condition as it may make it worse.

Bisphosphonate Medications

Bisphonsphonate medications are often used orally for the prevention or treatment of osteoporosis. Medical professionals have been worried that bisphosphonate medications lead to osteonecrosis of the jaw (ONJ).

Researchers have found that the oral use of the medication has been rarely linked to cause osteonecrosis. However, the intravenous use of bisphosphonates for particular cancer patients has been linked to osteonecrosis. The medication absorbs differently within the body depending on whether it is taken orally or intravenously, which is why the risks for developing ONJ are different between the two. Despite the definitive risk of oral bisphosphonates being unclear, researchers have decided that it is minimal.

When Does ONJ Occur?

A majority of the cases of ONJ from bisphosphonates have happened after surgical dental procedures. Although the condition can develop at any time, medical professionals are still recommending that patients getting intravenous bisphosphonate therapy attempt to avoid dental procedures that are surgical when possible.

If you happen to be taking bisphosphonate medications to treat osteoporosis or cancer, researchers recommend you maintain good oral hygiene to lower your risk of developing ONJ. This means brushing and flossing on a regular basis, and seeing your dental hygienist regularly for dental exams and cleanings.