Side Effects Noted with Bone-Loss Drugs

At least 10 million Americans, mostly women, take drugs to prevent bone loss from aging or advanced cancer. But doctors note a serious side effect affecting a fraction of patients: bone destruction in the jaw.

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DEBBIE ELLIOTT, host:

This is ALL THINGS CONSIDERED from NPR News. I'm Debbie Elliott. Millions of Americans take drugs to protect their bones against the effects of aging and cancer. But doctors now say the drugs actually destroy bone in a small fraction of people. Retired Air Force mechanic David Dontell(ph) of Pace, Florida took one of these drugs for osteoporosis. A few weeks ago doctors discovered that part of his jawbone had died. He had to have emergency surgery to repair a hole in his chin.

Mr. DAVID DONTELL (Retired Air Force Mechanic): When he was rinsing the thing out I could feel water coming in the inside of my jaw when he was spraying it from the outside. So that really got my attention.

ELLIOTT: The surgeon had to remove all of Dontell's teeth and scrape off dead portions of his jawbone. NPR's Richard Knox reports that the problem is posing a growing dilemma for patients and doctors.

RICHARD KNOX, reporting:

David Dontell was taking a drug called Fosamax. Doctors prescribe it for at least 10 million Americans to prevent osteoporosis, and it does. Fosamax reduces the incidence of fractures by 50%. Thousands of others with advanced breast, prostate and blood cancers get injections of similar drugs called bisphosphonates to prevent the cancer from destroying bone. But for unknown reasons the drugs can precipitate destruction of jawbone. It happened to a Long Island woman named Carol Meschow(ph).

Ms. CAROL MESCHOW (Long Island Resident): I started getting terrible sores in the roof of my mouth. I thought it was canker sores, thought it could be an infection. It was extremely painful. It affected my speech. It affected my eating, and this went on for about nine months before anybody knew exactly what it was.

KNOX: A doctor who had just seen another case told Meschow she had osteonecrosis of the jaw. It means jawbone death.

Ms. MESCHOW: It was just the heaviest type of diagnosis I can imagine receiving. Whatever could be the cause of this?

KNOX: Meschow had been taking Fosamax for eight years. She consulted oral surgeon Salvatore Ruggiero(ph) of Long Island Jewish Medical Center. He started seeing cases like hers in 2001.

Dr. SALVATORE RUGGIERO (Long Island Jewish Medical Center): We really didn't know what to make of it. What we did eventually do is just look at all the medicines these patients were taking and the one common denominator in all of them was the bisphosphonates.

KNOX: Bisphosphonates slow down the normal process of bone cell destruction and regeneration. That's a good thing for patients whose bones are being broken down faster than they can be renewed, but it's not a good thing for the jawbone in some people. Maybe because the cells in the jawbone die and regenerate faster than anywhere else. Ruggiero says the condition is very hard to treat. Surgery to remove dead bone can cause more bone death. He's seen 155 cases of jaw necrosis so far. Sixteen percent were taking pills like Fosamax. The others were getting more potent injected bisphosphonates.

Other doctors have identified several thousand more. It occurs in one to six percent of cancer patients getting these drugs. The risk is apparently much lower in osteoporosis patients.

Dr. RUGGIERO: Even though the number is very, very small, when you consider how many people have taken these medications, it can be a significant problem and I believe it's going to be.

KNOX: Most cases of jaw necrosis occur after the bone is injured, say by tooth extraction or a dental implant. Bone specialists around the country say they're getting questions from worried patients, dentists and other doctors.

Dr. CLIFFORD ROSEN (Bone Specialist): All the time. Calls all the time. We just had a patient Thursday call up saying I'm going to have a dental procedure, what should I do?

KNOX: Clifford Rosen is a bone specialist in Bangor, Maine.

Dr. ROSEN: What we've been recommending is if your planning a major dental procedure, stop the bisphosphonates, at least several months before the procedure is planned and several months after. Coming off the treatment for a period of time up to a year or so will probably not do those patients any harm.

KNOX: Rosen says an upcoming study indicates that osteoporosis patients who have been on a bisphosphonate drug for five years can go off the drug for as long as five years without losing bone mass. Of course cancer patients can't afford to stop taking the drug. Rosen says the jawbone problem is causing doctors to rethink long-term use of bisphosphonates.

Dr. ROSEN: We're going to see more studies addressing this issue. How long do people need to be on bisphosphonates? They may not need to be on for a lifetime.

KNOX: That question isn't limited to osteoporosis drugs. The jawbone problem shows that unexpected side effects often don't show up until millions of patients take a drug for many years. Richard Knox, NPR News.

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