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Cheyenne Advanced Dental Arts
L. Scott Brooksby, DDS, DICOI
Prosthodontist
8960 W. Cheyenne #190
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Dr. Brooksby, I have been told that I have Osteoporosis, but I have heard that there are problems with osteoporosis medications that affect the jaw. Can you tell me what can be done? Waning away. Dear Waning: Who does osteoporosis affectOsteoporosis has often been classified as a disease of the older women, but it actually can affect people of all ages. Hard training athletes, men and patients with chronic disease or hereditary, nutritional and lifestyle risk factors may also be afflicted with osteoporosis. One of the biggest concerns is that the bones of the spine, wrists, legs or hips may fracture more easily. The pharmaceutical companies have pushed the continuing education of medical doctors implying that without their medications the patients will suffer these problems more frequently. Many people believe that if they stop the cells that break the bone down, then that will keep the bone from breaking. The reality is that the break down of the bone is the first step in the remodeling process by which the body replaces old bone with new rejuvenated bone. On an x-ray the new remodeled bone does not look as dense as old bone. Drugs used for treatment of OsteoporosisThe most common group of drugs associated with treatment of osteoporosis is a family of drugs called bisphosphonates. These drugs work by interfering with the cells that break the bone down. It is incorporated into the bone and stops the cells that break the bone down from working. As the dosage increases the number of cells that stop functioning increases. Since the drug is not eliminated from the bone for about 14 years, as it builds up the rate of bone remodeling goes down. On an x-ray this looks as though the bone is getting better when in fact it is getting worse. This accumulation of drug in the bone is directly related to how fast the bone remodels. The jaw bone, for example, remodels ten times faster than the other bones in the body. For this reason the problems with the drug show up much sooner in the jaw bone than in other parts of the body. When the drug reaches a critical mass the skin and gum tissues will no longer stay attached to the bone and it falls of and the bone begins to die. The only successful treatment is a Peridex mouth wash and cessation of the medications. Steroid treatment together with the bisphosphonates seems to make this even worse. Incidence of bone death and effectiveness of the drugsDr. Robert Marx, one of the leading bone researchers in the world has stated that the research provided by the drug companies has been difficult to reproduce by independent researchers. Dr. Marx was one of the first to recognize the correlation between these drugs and the dying bone in the mouth. The current incidence of dying bone is less than 2% of those that take these drugs, about the same as the incidence of a dry socket after a tooth extraction. He has also indicated that there is a test that can be done to quantify the risk of developing this problem from these drugs. When asked how effective these drugs actually are at preventing fractures, Dr. Marx said that it would take 300 women taking these drugs for three years to prevent one fracture. Alternative treatmentsSo what do you do? The leading researchers recommend eating a healthy diet rich in calcium rich foods and getting enough vitamin D. This requires exposure to sufficient sunlight for the vitamin D to work. Some of the highest sources of bio-available calcium in foods would include uncooked leafy spinach and yogurt. Light to moderate exercise may also help. Things to avoid include alcohol, caffeine and smoking.Parathyroid hormone seems to be effective without the side effects. For more information on the affects of osteoporosis on your dental health schedule a free dental consultation with Dr. Scott Brooksby at , see http://lvimplant.com. If you have questions you would like answered in this column email Dr. Brooksby at scott@lvimplant.com |