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Tuesday, July 10, 2007

Advice about dental work, osteonecrosis (Fossy Jaw) and Fosamax

"My oral surgeon just alerted me to the possible side effects of Fosamax, which I have been taking for 3 years. We are considering jaw surgery and orthodontic work to correct a severe overbite. He has ordered a CTX test (I believe that's what he called it) to help determine my risk level for such a procedure. I am not familiar with this test and am wondering if it is accurate at predicting a successful recovery and healing."

I asked women's health researcher, Gillian Sanson, for advice:

"The CTX test is a bone marker test measuring collagen cross links. Osteoclast activity is measured by the breakdown products of collagen. When bone is resorbed collagen is broken down and fragments that contain the cross-linking molecules are released and excreted in the urine. High levels can indicate high levels of bone resorption. My understanding is that these tests are not a particularly accurate way of measuring bone metabolism, fracture risk, healing or otherwise because of the great variability in bone turnover, and the day to day variability of metabolic processes. But I am not an expert in this area. I don’t know about the use or value of this test in relation to osteonecrosis of the jaw.
Best wishes

"We recommend that patients about to start oral and intravenous bisphophonates should have an oral inspection by the rheumatologist, and if there are any doubts then the patient should be referred to an appropriate dental surgeon for further advice.

Secondly, we recommend that patients who are already taking oral bisphosphonates should not stop these when they go for dental surgery as the risk of ONJ is very small and the half-life of the bisphosphonates long.

Thirdly, we recommend that in patients who are already having intravenous bisphosphonates and who have planned dental surgery, the administration of the bisphosphonates should be delayed until after healing has been completed."
Gary Moller comments:
Margie, I am sorry that the following is rather grim; but best got out and understood.

Few adverse side effects ever get reported for a raft of reasons. So, if rates of complications are x/100,000 one can assume that the real rate is much higher. Claims that newer versions of these biphosphonates have fewer complications are rubbish. How can such claims be made when it takes ten or so years to really know? If I were to be taking medication from a particular class of drugs, I would probably prefer the one that has the longer track record - warts and all! None at all, if I could get away with it. If you troll the user support websites, you will see there is growing unease among the patients about this class of drugs and a disturbing number of reports of adverse reactions.

Bisphoshonates, including Fosamax, progressively kill off the little cells in the bone that are constantly working hard to remodel bone to withstand the stresses and strains of daily living on the skeleton. Killing these cells (osteoclasts and osteoblasts) gives just a couple of years of possible reduction of fractures. But this comes at a shocking cost.

Healthy bone is never more than about 7 years old regardless of age. The cost of taking bisphoshonates is the development of old and lifeless bone that, once damaged, will never again heal. Not only do these poisons kill off the cells that maintain the bones they remain in the body for an estimated 20 years (Estimated 1/2 life of 10 years) doing their damage.

The term "Fossy Jaw" is a play on Fosamax and refers to the horror of jaw bone death associated with the use of biposphonates. The reason why the jaw is so vulnerable is because it is constantly stressed by the chewing action and the pressure of teeth on the jaw bone. The rate of bone turnover in the jaw is very high so the poisoning effect of biphosphonates may be first seen in the jaw. Basically what happens is bone damage such as during orthodontic work and even simple extractions may result in non-healing lesions on the bone - ulcerations andf progressive loss of jaw bone. I will say no more, other than to say that this is one topic that makes my blood boil!

There may be similar processes of bone death caused by the use of blood thinners like Warfarin (rat poison). But this is another article!

Margie, that is the bad news over with; now for the good news.

The good news is that you are only a few years into it and the sooner you stop the better. You can stop right away; but I do recommend that you talk about your intentions with your doctor. The fact that your orthodontist felt required to carry out tests to try to assess your bone cell activity should be sufficient warning to you to take positive and assertive action. Get off the stuff!

Can you delay the orthodontic work for a couple of years? Surely it can wait? Talk frankly to your orthodontist about this. I think you should give your jaw bone time to recuperate from any effects of the biphospenates. The orthodontic work requires tip-top bone health.

Strengthen and revitalise your bones through natural health measures:
  • Get your vitamin D levels tested and follow the guidelines on this website to aggressively get your levels up to about 120nmol (details on this site)
  • Have a daily mineral rich cup of beef/lamb bone broth
  • Take daily supplements of vitamin A rich cod liver oil
  • If you can get full cream raw milk, do so and then have 1-2 cups per day (Keep and eye on this website because I am looking at publicising sources)
  • Exercise daily including lifting light weights above your head (My book on back pain has suitable illustrated exercises for you.
Bone up on osteporosis: Go to the Search This Blog box in the upper right hand column of this website and do a search for terms like "osteoporosis" and "fosamax" and have look at all of the articles on this site, linked sites and the rest of the web.
Margie, the best response is ACTION! So get moving and please keep us posted about what you do and how it all goes.

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