If you've been watching the news, you may have heard about a new, rare yet serious side effect of Fosamax® (alendronate) and other osteoporosis drugs. Recently, these medications have been linked to a condition called 'osteonecrosis'. Many patients taking these medications have experienced serious jaw bone damage as a result. The word 'osteonecrosis' literally means 'dead bone'. When it happens in the jaw area, this condition causes a weakening and dying of the bone in the jaw bone and it is very hard to reverse.

Other medications in this class that can cause this condition include Zometa® (zoledronic acid), Aredia® (pamidronate), Actonel® (risidronate), and Boniva® (ibandronate). About 94% of these cases have happened in cancer patients getting long-term treatment with IV osteoporosis meds like Zometa and Aredia¹. For those taking medications by mouth like Actonel, Fosamx and Boniva, the incidence is much less.  Many of these cases have happened right after trauma to the jaw like a tooth extraction.

Prevention of osteonecrosis is important as it is very hard to treat once you get it. It is important to practice good oral hygiene. It may be a good idea to alert your dentist that you are on the medication and get a dental exam at the beginning of therapy. This way, you can take care of any serious dental procedures before you have been on the drug long-term. Although more evidence is coming in, simply stopping the drug before a dental procedure may not be enough to prevent damage. These drugs can stay in the bone for years. Above all, one should not be alarmed as this side effect is extremely rare in those taking oral osteoporosis medications.

Author: Christi Larson, Pharm. D.

REFERENCES:

1. Sook-Bin Woo, DMD; John W. Hellstein, DDS, MS; John R Kalmar, DMD, PhD. Ann Intern Med. 2006; 144:753-761.