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Bisphosphonates and Their Impact on Patient Treatment Bisphosphonates and Their Impact on Patient Treatment

Author(s):

Lee H. Silverstein, DDS, MS, FACD, FICD;Gregori M. Kurtzman, DDS, John Peden, DDS

Date Added:

7/18/2008


Summary:

There has been increasing discussion concerning a variety of implications for patients who have been administered bisphosphonates, which are FDA-approved chemical agents used in the treatment of osteoporosis, metastatic cancer involving the bone, and Paget's disease. I The first report of the biological characteristics of bisphosphonates was published in 1968, when scientists discovered that bisphosphonates have a marked ability to inhibit bone resorption. Bisphosphonates suppress or reduce bone resorption by osteoclasts by hindering the recruitment and function of osteoclasts and by sti mulating osteoblasts to produce an inhibitor of osteoclast formation. Though they suppress the abnormal bone resorption and pain associated with Paget's disease, fibrous dysplasia, and metastatic bone cancer, bisphosphonates do not cure disease. There is increasing evidence, however, that patients who have been treated wi th bisphosphonates may be susceptible to osteonecrosis associated with dental surgical procedures such as extractions, implant placement, and infections involving cran iofacial bone. It has been suggested that these changes may leave the patient more susceptible to osteonecrosis, are long term, and cannot be reversed by discontinuing usage of the medication. Bisphosphonates inhibit bone resorption and thus bone renewal by suppressing the recruitment and activity of osteoclasts, thus shortening their lifespan. In a study of 119 cases of bisphosphonate-related bone exposure, Marx reported that dental comorbidities were found including the presence of periodontitis (84%), dental caries (28.6%), abscessed teeth (13.4%), root canal treatments (10 9%), and mandibular tori (9 2%) The precipitating event that produced the bone exposures were extractions (378%1, advanced periodontitis (28.6%), spontaneous occurrences (25.2%), periodontal surgery (11.2%), dental implants (3.4%), and root canal surgery (0.8%).

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