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    Osteoporosis & Dental Issues
    cdmarie57 posted:
    I have been taking Fosamax for several years due to osteopenia hip/spine and a strong family history of osteoporosis.
    I also have TMJ and part of the treatment plan I am under involved 4 teeth extracted, wearing braces now, and a lower jaw surgery next January.
    I had to sign a document for the oral surgeon that I was aware of the possibility of osteochondrosis after taking bisphosphonates. I quit taking Fosamax 4 months before the treatment. I realize now that it stays in my bones for years. My gynocologist recently prescribed Evista to replace the Fosamax. There was no discussion about my choices of treatment. I am now concerned about taking the Evista with my mother's health history of strokes & blood clots. She also suffers from severe osteoporosis and 2 of my 4 sisters have osteoporosis. We are all under the age of 55.
    Are there other drug treatment possibilities? Osteoporosis is a real concern for me as I watch my mother shrink and suffer from this disease. I do weight bearing exercises, take calcuim supplements, and eat healthy.
    thanks for reading this!
    bonebabe responded:
    You certainly have reason to be concerned about your risk of osteoporosis and the fractures it can cause. My personal opinion is that your risk of fracture greatly outweighs your risk of osteonecrosis of the jaw. The National Osteoporosis Foundation issued a public statement about this on their website - . Basically they stated that the cases of jaw necrosis among healthy people taking oral bisphosphanates were few and far between, and, as with any medication, a person must weigh the benefits of the medication against any risks or side effects.

    The Evista is also a good drug and is only a risk for people who themselves have a history of blood clots. You might also want to consider Reclast, the yearly IV drug.

    You have a lot to think about, and it won't be an easy decision. While you don't say what your DXA scores are and if you're postmenopausal, your family history is very strong.

    Just make sure your're getting 1200 mg of calcium (split the doses throughout the day) and 1000 IU of Vitamin D. If you haven't had your Vitamin D levels checked, ask your doctor about doing this. It could make a tremendous difference in your bone health if you're found deficient.
    Michael Lewiecki, MD, FACP, FACE responded:
    You raise a number of issues that may be of general interest as well. While I cannot give you individual medical advice, I would like to rephrase your questions and answer them in a way that I hope you and others will find helpful.

    1. Which patients with osteopenia should be treated with drugs to reduce the risk of fractures? The National Osteoporosis Foundation recommends that untreated postmenopausal women and men age 50 and older who have osteopenia (T-score at the lumbar spine or femoral neck between -1.0 and -2.5) and no history of hip or spine fracture should be considered for starting drug therapy when the FRAX estimation of the 10-year probability of hip fracture is 3% or more or the 10-year probability of major osteoporotic fracture is 20% or more. You or your physician can find the FRAX website online and do these calculations on information that was available several years ago, before treatment was started. More information about FRAX is also available at .

    2. What is the risk of osteonecrosis of the jaw (ONJ) with osteoporosis medication? ONJ is defined as an area of exposed bone in the mouth that has persisted more than 8 weeks after identification by a healthcare professional, in a patient who has taken a bisphosphonate (such as alendronate [Fosamax>) and not had radiation therapy to the jaw. About 95% of cases have been in cancer patients receiving very high doses of these medications. The risk of having this from treatment of osteoporosis with a bisphosphonate is very low- about 1 in 100,00 patient-treatment years. By comparison, this is much lower than the risk of being killed in a car accident or being murdered. ONJ has nothing to do with TMJ syndrome. It is not known whether stopping the drug before a tooth extraction changes the risk of getting ONJ.

    3. What is the role of raloxifene (Evista) in treating osteoporosis? This drug acts the same as estrogen is some parts of the body and the opposite in others. It reduces the risk of fractures and reduces the risk of invasive breast cancer. It also increase the risk of blood clots and in women at high risk for cardiovascular disease it increases the risk of dying after a stroke, although it does not increase the risk of having a stroke in the first place. This drug should not be taken by women who have had blood clots in the past or those who are at high risk for cardiovascular disease.
    phototaker replied to gottehrer's response:
    Could you send a link to research done to show you've been able to do this? I looked on-line and didn't see anything.

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