Randy Sheffield, a member of the Malecare Advanced Prostate Cancer Online support group recently has had his fight with advanced prostate cancer made even more complex when he developed Osteonecrosis of the jaw (ONJ). ONJ is an uncommon but terrible side effect of taking bisphosphonates.
Randy wrote a warning to all the members of the group, a warning that bears repeating to all the readers of the blog:
“I was diagnosed September 2004 with prostate cancer and initially treated with brachytherapy. This was followed overtime with Lupron, Casodex, External Beam Radiation, Quadramet, Zoladex, Ketoconazole and Hydrocortisone, Provenge, Taxotere, Zytiga, Xtandi, and I have finished four of six planned Xofigo infusions. During the course of this treatment, bisphosphonates were added to increase bone strength. Initially Fosamax (oral) and then Zometa (infused).
In January of 2014, family dentist, with referral to periodontist, neither of whom could diagnose swelling of jaw behind lower incisors. Drugs (doxycycline and penicillin) did nothing so the periodontist suggested the best/only way to diagnose was with surgery, initially on February 21 and again on April 4.
Still no diagnosis but metastases was ruled out after a biopsy came back negative. The teeth would not “firm” up in the jaw after surgery and the crowning blow was when one fell out August 25. The periodontist immediately referred me to an oral/maxillofacial surgeon who diagnosed osteonecrosis of the jaw (ONJ) related to my prior bisphosphonate use, specifically Zometa.
Yes, the warning labels say to avoid tooth extraction and oral surgery while receiving bisphosphonates since the dental surgery may cause ONJ. Since I had not received Zometa since June 21, 2011, my medical oncologist and periodontist felt periodontal surgery was okay.
Wrong, I now find out! My oral surgeon informed me Zometa could linger in the system for an extended period of time. The American Academy of Family Physicians (2012) stated the half-life of bisphosphonates is up to 12 years! My oral surgeon has since removed the remaining three lower incisors and a portion of the jawbone to stop the spread of ONJ.
I am now on additional drugs to prevent infection and to improve blood flow in the body. This is one more obstacle in my 10-year battle with mCRPC.
I simply want to make you all aware of this potential issue and the length of time chemicals may remain in your body. We remain cautiously optimistic.”
I want to thank Randy for sharing this sobering experience. If you are getting ready to move on to a bisphosphonate make sure that you consult with your dentist and have any and all dental work needed taken care of prior to starting the drugs. Make sure that you become obsessive about your oral care to eliminate the possibility of needing serious dental work in the future.
If you have been on bisphosphonates and do need dental work make sure that your dentist is experienced in treating people with a history of taking bisphosphonates.
If you are interested in joining our advanced prostate cancer online group go to www.groups.yahoo.com. Then browse the Groups directory or search for our group which is named advancedprostatecancer. Click Join This Group in the upper-right corner of the group’s page
Joel T. Nowak, M.A., M.S.W.