Associate Professor of Clinical Medicine
Keck School of Medicine
University of Southern California
Los Angeles, California
Can we minimize the risk of osteonecrosis of the jaw?
Hello, I am Dr. Ann Mohrbacher from University of Southern California. I think many of us have been concerned about a potential complication of our use of bisphosphonates in our cancer patients, myeloma patients included, of osteonecrosis of the jaw. This is a relatively recently recognized phenomenon although I think news has spread and we are all very familiar with it and very concerned about it. Of course, we incorporated bisphosphonates very appropriately many years ago when we had less effective drug regimens and over the years of continuing to use them started to recognize this phenomenon. Dentists are very well informed about it, I find as well, in fact to the point where they are sometimes reluctant to do any treatment on multiple myeloma patients. Remember that the predominant incidence of this has been associated with bone disturbing procedures on the jaw such as dental extractions, fillings; root canal seemed to be relatively safe. On the other hand, what we do not have a good perspective on is how many months may be elapsed before that risk is reduced, and in fact, we often suggest that there would be a three-month wait before a dental extraction is done and three months hiatus as well after the dental extraction before using the bisphosphonates again. It is not clear whether there is really any evidence to support that, it is just a guess that we should avoid them in a certain timeframe around the use of those procedures. On the other hand, it has led to some reevaluation of where and how we are using bisphosphonates. In the historical regimens we used, patients were placed on the monthly practically indefinitely. Now, there are some newer recommendations coming out, again strictly empiric not based on evidence, that perhaps we should continue that pattern for about two years and then reassess whether the patient still needs them or should go on some form of quarterly management, and I think that really has to play in the clinical factors for that individual patient. Do they have very significant bone disease? Do they have severe osteoporosis? Have we seen some improvement in their general bone density score? Because we, of course, have to weigh the risk and benefit of use of those agents and protecting them against further complications.
| < Prev | Next > |
|---|