Clipping Board » Drug Poisoning ─ It is necessary to be aware of the toxic side effects before taking medication.
Chinese Health Network Reporter Zhang Shijie / Taipei Report | October 29, 2012
"Bone-preserving drugs" may have side effects! A woman in her 50s, who had been undergoing long-term chemotherapy for breast cancer, visited a clinic due to toothache and had a tooth extracted. After the extraction, the wound remained numb, painful, and even oozed pus. Upon examination at Dalin Tzu Chi Hospital’s dental department, it was discovered that a hole had formed in the lower right jawbone. Further inquiry into her medication history revealed that the culprit was a drug called "bisphosphonate," commonly known as a "bone-preserving drug."
Zheng Chaohong, director of the dental department at Dalin Tzu Chi Hospital, pointed out that bisphosphonate drugs are highly effective in inhibiting osteoclasts and are often used to treat bone metastases in cancer patients or osteoporosis. However, an increasing number of studies have confirmed that bisphosphonates excessively suppress bone metabolism, leading to osteonecrosis. Ironically, prolonged use of these bone-preserving drugs can sometimes result in the side effect of bone necrosis.
Clinically, bisphosphonates are divided into oral and injectable forms. Initially, the risk of jaw necrosis from oral bisphosphonates is relatively low, approximately one in ten thousand. However, as the duration of use extends beyond three years, the likelihood of jaw necrosis increases significantly.
For injectable bisphosphonates, the risk of jaw necrosis is about 1%, with the high-risk period beginning after roughly one year of use. If a patient undergoes tooth extraction or dental surgery while taking the medication, the risk increases by 5 to 21 times. It is recommended that patients undergo preventive dental treatment before starting bisphosphonate therapy.
Last year, the Department of Health mandated that all bisphosphonate-containing drugs include warning labels on their product information. While bisphosphonates remain effective in inhibiting bone metastases in cancer and treating osteoporosis, dental procedures such as tooth extraction or implants may increase the risk of jaw necrosis or atypical femoral fractures.
▲ A woman in her 50s had a hole in the lower right jawbone. (Photo provided by Dalin Tzu Chi Hospital)
Why would bone-preserving drugs cause osteonecrosis? Dr. Zheng Chaohong explained that bisphosphonates work by inhibiting osteoclasts to increase bone density. However, this also disrupts normal bone metabolism, preventing the renewal of aged bone and hindering the formation of new bone. This results in denser but more brittle bone that cannot self-repair once damaged.
Dr. Zheng emphasized that treating jaw necrosis requires long-term follow-up and necessary surgeries. Prevention is key to avoiding such side effects. The most crucial measure is establishing a referral and communication system among specialists, including hematology-oncology, orthopedics, and rheumatology departments.
Patients should undergo an oral evaluation at least three weeks before starting bisphosphonate therapy, with any necessary extractions or dental treatments completed beforehand. During bisphosphonate treatment, patients should inform their dentists of their medical history before undergoing tooth extraction or dental surgery and, if necessary, follow recommendations to discontinue the medication.Source: http:/ / tw. news. yahoo. com/ % E4……3% 9E% E6% AD% BB- 035605188. html;_ylt=Au2f_f5Btm9UdMhqp.rjRSOVBdF_;_ylu=X3oDMTRndnNycWo1BG1pdANTZWN0aW9uTGlzdCBGUCBIZWFsdGggTUQEcGtnAzVlZGRmZDkxLWNhODgtMzg4Ni1iNTUxLThkZTIzMTk2ZjE5ZARwb3MDMwRzZWMDTWVkaWFCTGlzdE1peGVkTFBDQVRlbXAEdmVyAzhmZjI3OGIwLTIxN2MtMTFlMi1iZjNiLThhMGI2NWJlMDRlMA--;_ylg=X3oDMTFucXJnOGdpBGludGwDdHcEbGFuZwN6aC1oYW50LXR3BHBzdGFpZAMEcHN0Y2F0A2hvbWUEcHQDc2VjdGlvbnM-;_ylv=3
Bone Drug Fails, Jaw Necrosis in Breast Cancer Patient
"Bone-preserving drugs" may have side effects! A woman in her 50s, who had been undergoing long-term chemotherapy for breast cancer, visited a clinic due to toothache and had a tooth extracted. After the extraction, the wound remained numb, painful, and even oozed pus. Upon examination at Dalin Tzu Chi Hospital’s dental department, it was discovered that a hole had formed in the lower right jawbone. Further inquiry into her medication history revealed that the culprit was a drug called "bisphosphonate," commonly known as a "bone-preserving drug."
Zheng Chaohong, director of the dental department at Dalin Tzu Chi Hospital, pointed out that bisphosphonate drugs are highly effective in inhibiting osteoclasts and are often used to treat bone metastases in cancer patients or osteoporosis. However, an increasing number of studies have confirmed that bisphosphonates excessively suppress bone metabolism, leading to osteonecrosis. Ironically, prolonged use of these bone-preserving drugs can sometimes result in the side effect of bone necrosis.
Clinically, bisphosphonates are divided into oral and injectable forms. Initially, the risk of jaw necrosis from oral bisphosphonates is relatively low, approximately one in ten thousand. However, as the duration of use extends beyond three years, the likelihood of jaw necrosis increases significantly.
For injectable bisphosphonates, the risk of jaw necrosis is about 1%, with the high-risk period beginning after roughly one year of use. If a patient undergoes tooth extraction or dental surgery while taking the medication, the risk increases by 5 to 21 times. It is recommended that patients undergo preventive dental treatment before starting bisphosphonate therapy.
Last year, the Department of Health mandated that all bisphosphonate-containing drugs include warning labels on their product information. While bisphosphonates remain effective in inhibiting bone metastases in cancer and treating osteoporosis, dental procedures such as tooth extraction or implants may increase the risk of jaw necrosis or atypical femoral fractures.
▲ A woman in her 50s had a hole in the lower right jawbone. (Photo provided by Dalin Tzu Chi Hospital)
Why would bone-preserving drugs cause osteonecrosis? Dr. Zheng Chaohong explained that bisphosphonates work by inhibiting osteoclasts to increase bone density. However, this also disrupts normal bone metabolism, preventing the renewal of aged bone and hindering the formation of new bone. This results in denser but more brittle bone that cannot self-repair once damaged.
Dr. Zheng emphasized that treating jaw necrosis requires long-term follow-up and necessary surgeries. Prevention is key to avoiding such side effects. The most crucial measure is establishing a referral and communication system among specialists, including hematology-oncology, orthopedics, and rheumatology departments.
Patients should undergo an oral evaluation at least three weeks before starting bisphosphonate therapy, with any necessary extractions or dental treatments completed beforehand. During bisphosphonate treatment, patients should inform their dentists of their medical history before undergoing tooth extraction or dental surgery and, if necessary, follow recommendations to discontinue the medication.Source: http:/ / tw. news. yahoo. com/ % E4……3% 9E% E6% AD% BB- 035605188. html;_ylt=Au2f_f5Btm9UdMhqp.rjRSOVBdF_;_ylu=X3oDMTRndnNycWo1BG1pdANTZWN0aW9uTGlzdCBGUCBIZWFsdGggTUQEcGtnAzVlZGRmZDkxLWNhODgtMzg4Ni1iNTUxLThkZTIzMTk2ZjE5ZARwb3MDMwRzZWMDTWVkaWFCTGlzdE1peGVkTFBDQVRlbXAEdmVyAzhmZjI3OGIwLTIxN2MtMTFlMi1iZjNiLThhMGI2NWJlMDRlMA--;_ylg=X3oDMTFucXJnOGdpBGludGwDdHcEbGFuZwN6aC1oYW50LXR3BHBzdGFpZAMEcHN0Y2F0A2hvbWUEcHQDc2VjdGlvbnM-;_ylv=3