March 28, 2019

is fosamax safe?I received a request for info from a patient this morning regarding Fosamax, a bone sparing medication that is given to older individuals (mostly women) suffering from osteoporosis.

Here’s the gist of it:

Bones are living and growing structures. They are constantly being broken down and built up again throughout our life. Specialized cells within the bone called osteoclasts remove bone tissue in order for new bone tissue to be formed. They do this by transferring calcium from the bone into the blood. Cells called osteoblasts help to rebuild the bone by laying down new bone tissue material. This process is called bone remodeling.

In healthy individuals bone is constantly being remodeled to respond to ongoing changes in load upon it. Thus osteoclasis (the removal of bone tissue by osteoclasts) is a necessary part of bone remodeling and a necessary part of bone health. Additionally, bone undergoes micro-fractures when it is under load and requires constant repair. Bone remodeling requires both bone resorption as well as bone deposition.

Osteoporosis is a bone disorder that occurs when something disrupts this constantly occurring life-long process of bone remodeling. The result is an excessive resorption of bone by the osteoclasts.

You may be more predisposed to the development of osteoporosis if you:

  • are female, particularly post-menopausal
  • are > 50 years of age
  • have a diet that is low in calcium
  • are thin
  • lead a lifestyle that is more sedentary than it is active
  • have hyperthyroidism or take too much thyroid hormone
  • have an intestinal problem that prevents calcium and vitamins from being absorbed
  • take certain medications, for example prednisone
  • are Caucasian or of Asian descent
  • have a family history of osteoporosis
  • smoke and/or drink too much alcohol

How does Fosamax work?

Fosamax comes from a family of drugs called “Biphosphonates” which inhibit the specialized osteoclast cells from doing their job of removing bone tissue.

The use of agents such as Fosamax to inhibit osteoclasis pre-supposes that osteoporosis can be corrected (or in other words that the bones will be made stronger) by suppressing the process of bone resorption and thereby brings the equilibrium between bone resorption and bone deposition into balance.

The most common route of administration of these bone-sparing medications is via the oral route (pills) and this very rarely causes problems. In few extreme cases the medication is administered via intravenous injections. Many patients who require this will only receive a single injection per year.

I heard that there is a potential risk associated with the gums and jawbone. Is this true?

Yes. In rare cases this is true.

The complications with Fosamax in relation to dental are called “Bisphosphonate-related osteonecrosis of the jaw” (BRONJ). For example, when you have an extraction done or experience trauma to the jawbone the bones mechanisms for repairing itself are impaired and can lead to necrosis in the area.

The powerful injections mentioned earlier have also been found, in even more rare cases, to be associated with a condition called osteonecrosis or “avascular necrosis” where parts of the jawbone can die. They become so highly calcified that there is essentially no live cells in them to effect repair. This condition is accompanied by patches of bone losing the covering of gum tissue and thus presents a surface of dead bone.

Fortunately these cases appear to be extremely rare. To the best of my knowledge they are almost exclusively seen alongside the long-term administration of the injectable forms of these bone-sparing medications such as Fosamax.

For further personal research visit Fosamax on Drugs.com. This blog is intended for educational purposes only and does not represent medical advice specific to your personal circumstance. Please contact your doctor for advice, diagnosis and information regarding if Fosamax is right for you.

Article written by Dr. Adrian Pawlowski, DDS MSD of Bell Harbour Dental clinic in Dowtown Seattle.

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