SATURDAY, Oct. 15 (HealthDay News) -- People suffering from a
disfiguring loss of bone in the jaw may find help in the form of a
long-used osteoporosis drug, two new studies suggest.
Besides being linked to chronic, severe gum disease, this type
of bone loss has also been connected in rare cases to the use of
bisphosphonates, a different class of osteoporosis drugs.
But the two papers in the Oct. 16 online issue of the
New England Journal of Medicine report success with
teriparatide (Forteo) in rebuilding bone.
One report describes the case of an 88-year-old woman who had
been taking the bisphosphonate alendronate (Fosamax) since
suffering a hip fracture 10 years earlier. She had also been taking
the corticosteroid prednisone for two decades.
Experts have already noticed an uptick in the incidence of this
rare but devastating condition in patients using
According to an editorial accompanying the study, this
complication occurs in about 5 percent of cancer patients who are
taking a high-dose bisphosphonate (Zometa or Aredia) to control or
prevent spread of malignancy to the bone. It is much rarer in
people who take a lower-dose bisphosphonate (such as Actonel,
Boniva or Fosamax) for osteoporosis.
The 88-year-old woman described in the journal report had been
experiencing pain in her jaw for a year and was subsequently
diagnosed with osteonecrosis, a debilitating "death" of bone due to
loss of blood flow.
After eight weeks of treatment with Forteo, though, the pain
went away and the osteonecrosis resolved, reported the authors,
from Austin Health in Melbourne, Australia.
The editorial pointed out, however, that Forteo should not be
used in patients whose cancer has already spread to the bone, as it
might prompt even more spread.
It's also possible that the corticosteroid therapy she was
taking could have contributed to the woman's bone loss, the authors
The second paper involved 40 patients with severe gum disease
that had affected their jaws, all of whom first underwent surgery
on their jaw. They were then randomized to receive either Forteo or
a placebo. All participants took calcium and vitamin D as well.
"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 of therapy, patients in the Forteo arm saw
greater healing of their jawbone and this continued throughout one
year of follow-up.
"There was a significant improvement in clinical measures of gum and bone," McCauley stated.
But, she pointed out, Forteo is not yet approved for this
indication, so "we can't recommend it next week."
Right now, a bone graft is probably the most common type of
therapy for this type of bone loss, she said.
"I think that it's really an important important proof-of-concept that you can inject locally and get a response," said Dr. Rena D'Souza, chair of biomedical sciences at Texas A&M Health Science Center Baylor College of Dentistry in Dallas. "We could not only use this approach for the treatment of periodontal disease where the disease enters the bone and gum. but also other forms of periodontal disease."
"Bisphosphonates cut back on blood flow and blood vessels so that cancer doesn't have a chance," she said. "That is why it's used very effectively for cancer but if you happen to injure the bone or take out a tooth you really need the blood vessels. The bone cells don't have the ability to lay down new bone."
American Academy of Periodontology has more on gum disease.
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