Contemplating medicine and the health care system
Drug for Bones Is Newly Linked to Jaw Disease
In the last 10 years, millions of patients have taken a class of drugs that can prevent agonizing broken and deteriorating bones. The drugs once seemed perfectly safe and have transformed life for patients with cancer or osteoporosis.
But recently there have been reports of a serious side effect: death of areas of bone in the jaw.
Everyone agrees that the condition, osteonecrosis of the jaw, is an uncommon complication, but that its true incidence is not known. It is estimated that among the 500,000 American cancer patients who take the drugs because their disease is affecting their bones, 1 to 10 percent may develop the problem.
As for the millions of osteoporosis patients, who take lower doses, the condition seems less common. But no one knows how much less. Some oral surgeons have as many as a couple of dozen cases, but their clinics have become centers to which patients elsewhere are referred. Among people with osteoporosis, only 15 cases of the new ailment have been reported in the medical literature.
This is new to me. Bisphosphonates have greatly improved our management of osteoporosis. Many patients take these drugs with great benefit. This new side effect must be better understood. It may not preclude using bisphosphonates, but the side effect and its probability must be considered in treatment decisions.
Of course, I did see a TV ad looking for patients who have suffered this complication – from a prolific TV advertising litigator.
This class of drugs is valuable. The side effect is concerning, but fortunately not lethal. We need to understand more about this condition.
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2 Responses to A rare side effect for bisphosphonates
ben
June 3rd, 2006 at 2:07 pm
Jaw osteonecrosis seem to be a RARE side effect in the context of treatment with biphosphonates in malignancy.
But the rarity of this side effect is definitely overwhelmed by the attention recently given to it by the media.
In a coverage by foxnewstv at the metropolitan washington dc area, late April or early May, a dental surgeon even gave a soundbyte in the report indisinuating how general internists prescribe fosamax left and right – irresponsibly unaware of this side effect. It is rare, in rare settings and should not be irresponsibly sensationalized by doctors whom, as you indicated may have seen it in the teen times, yet became consultants about the condition. This gives more fodder for the litigants who drive up healthcare costs for no productive value to society.
ba
June 3rd, 2006 at 7:01 pm
This makes me more interested in the Japanese’ commercial development of vitamin K2, the menaquinone-4 (MK4, menatetrenone) vitamer that has a corresponding transport protein in the human body. The Japaanese have very interesting results with osteoporosis and liver cancer remissions in 45+ milligrams/day to over 90 mg/d MK4. (that’s mg, *not* mcg). Here in the US , the work that suggests using it to keep the calcium in bones instead of migrating to the arteries is also interesting. Along with mixed tocopherols as “blood thinner”…