Taking bisphosphonates as a part of our prostate cancer treatment puts all of us in direct risk of developing osteoporosis. Bisphosphonates have been found to place us in a high-risk state for developing osteonecrosis of the jaws (rotting of the jaw bones).
It is now possible to use X-rays to detect “ghost sockets” in the jaw. When these sockets are found, it signals that the jawbone is not healing correctly and there is a great risk of developing osteonecrosis of the jaw. Early detection of these ghost sockets may help us to avoid permanent damage to the jawbone, according to an article in the March/April 2009 issue of General Dentistry.
A ghost socket occurs when the jawbone is not healing and repairing itself the right way. “The good news is that even though these ghost sockets may occur, by using radiographic techniques we can see that the soft tissue above these sockets can still heal,” according to Kishore Shetty, DDS, MS, MRCS, lead author of the report. Dr. Shetty states these findings are important news to learn about because early prevention and detection can halt permanent damage from happening to a patient’s jawbone.
Bisphosphonates are a family of drugs used to prevent and treat osteoporosis, multiple myeloma, Paget’s disease (bone cancers), and bone metastasis from other cancers, including prostate cancer. Commonly their use in prostate cancer is to both prevent, or slow down the progress of osteonecrosis caused by hormone therapy (ADT) and to also make the bone less available to prostate cancer cells as they try and metastasize. They work by bonding to bone surfaces and prevent osteoclasts (cells that break down bone) from doing their job. Other cells are still working trying to form bone, but it may turn out to be less healthy bone leading to the ghost-like appearance on X-rays.
“Healthy bones can easily regenerate,” says Dr. Shetty. “But, because jawbones have rapid cell turnover, they can fail to heal properly in patients taking any of the bisphosphonate drugs. It’s very important for patients to know about complications from dental surgery or extractions. Since these drugs linger in the bone indefinitely, they may upset the cell balance in how the jaws regenerate and remove unhealthy bone.”
According to AGD spokesperson Carolyn Taggart-Burns, DDS, FAGD, patients who are taking bisphosphonates should inform their dentist to prevent complications from dental surgical procedures. Have you informed your dentist that you take bisphosphonates?
Joel T Nowak MA, MSW