date: 3/6/2006
Bone-building drugs: New risk explained
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Three widely used bone-bolstering drugs now carry warnings that they can actually have the opposite effect in the jaw, causing osteonecrosis, or irreversible bone destruction. But the risk from those drugs—alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel)—is far less alarming than some reports suggest.
Most of the studies that prompted the warning involved people treated for a type of bone cancer, not osteoporosis. Those patients received high doses of stronger, intravenous versions of those drugs, called bisphosphonates, to relieve bone pain and prevent fractures. So far, only a tiny percentage of people who take the pills for osteoporosis—an estimated 1 per 20,000 users—have developed osteonecrosis, and their cases tended to be much milder. Bisphosphonates pose one other rare, serious risk: eye inflammation, which can permanently harm vision. However, discontinuing the drug immediately and using prescription eye drops clears up the inflammation.
Overall, Consumer Reports' medical consultants say those low risks do not warrant avoiding bisphosphonates, which remain the optimal treatment for osteoporosis, a potentially crippling, life-threatening disease. But be sure to tell your dentist you're taking the drug and to get regular dental exams. And discuss the bone risk with your doctor and dentist before undergoing tooth extraction or implantation, which may increase the risk of the drug-induced osteonecrosis. Ideally, you should stop the medication for a few months before and after such treatment. And call your ophthalmologist and prescribing physician at the first sign of redness or pain in the eyes or blurred vision.
Most of the studies that prompted the warning involved people treated for a type of bone cancer, not osteoporosis. Those patients received high doses of stronger, intravenous versions of those drugs, called bisphosphonates, to relieve bone pain and prevent fractures. So far, only a tiny percentage of people who take the pills for osteoporosis—an estimated 1 per 20,000 users—have developed osteonecrosis, and their cases tended to be much milder. Bisphosphonates pose one other rare, serious risk: eye inflammation, which can permanently harm vision. However, discontinuing the drug immediately and using prescription eye drops clears up the inflammation.
Overall, Consumer Reports' medical consultants say those low risks do not warrant avoiding bisphosphonates, which remain the optimal treatment for osteoporosis, a potentially crippling, life-threatening disease. But be sure to tell your dentist you're taking the drug and to get regular dental exams. And discuss the bone risk with your doctor and dentist before undergoing tooth extraction or implantation, which may increase the risk of the drug-induced osteonecrosis. Ideally, you should stop the medication for a few months before and after such treatment. And call your ophthalmologist and prescribing physician at the first sign of redness or pain in the eyes or blurred vision.
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