Ann Arbor, MNIt is one of life's ironies that an osteoporosis drug can treat a disease caused by another osteoporosis drug. But that seems to be the case for a woman diagnosed with Fosamax osteonecrosis, otherwise known as Fosamax dead jaw. The patient in question, an 88-year-old woman, had been taking Fosamax (bisphosphonate alendronate) for some 10 years since suffering a hip fracture in her seventies.
The woman was not identified. However, her plight was recently highlighted in the October 16, 2010 online issue of the New England Journal of Medicine (NEJM).
Fosamax osteonecrosis of the jaw, also known as Fosamax ONJ, is rare. As it is, patients taking high-dose bisphosphonates risk developing the condition in five percent of cancer patients. For those on lower-dose bisphosphonates such as Fosamax, the occurrence of Fosamax jaw issues are that much more rare.
But it does happen, as it did with our 88-year-old subject. The NEJM report described the woman as suffering pain in her jaw for more than a year before her ultimate diagnosis of osteonecrosis, or dead jaw. The latter is essentially the debilitating "death" of bone due to loss of blood flow.
It's ironic that a drug designed to strengthen bone, has such an effect. But it can, and does—and lawsuits have resulted. The resulting death in the bone and bone loss can have a devastating affect on how an individual eats, talks, and on other functions of the jaw most of us take for granted.
However, according to one of two papers published online October 16th in the NEJM (together with an accompanying editorial), an eight-week course of Forteo (teriparatide) reportedly resolved the woman's Fosamax dead jaw, together with the pain she had been experiencing.
The study authors, based in Australia, noted that the use of corticosteroid prednisone for two decades might have contributed to the woman's osteonecrosis.
An accompanying paper studied 40 patients suffering from severe gum disease, all of whom underwent surgery on the jaw. They were then randomized to receive either teriparatide or a placebo, together with calcium and Vitamin D.
"These were patients with severe periodontal disease but who were otherwise systemically healthy," said study senior author Dr. Laurie K. McCauley, chair of the department of periodontic and oral medicine at the University of Michigan in Ann Arbor.
After six weeks, "there was a significant improvement in clinical measures of gum and bone," McCauley said. She noted that teriparatide is not approved for such an indication.
Still, it could be encouraging news for Fosamax patients suffering from Fosamax side effects.
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