WebDental

Social network for dentists and dental professionals to share news and ideas.

Following the encouraging publications from the last couple of years, we start seeing more and more patients being treated with Aclasta® (zoledronic acid 5 mg) for osteoporosis. Since this yearly infusion increases bone mineral density (BMD) at the lumbar spine significantly ( better than oral risedronate 5mg taken daily ) and has the advantage of improved compliance, it is used as a replacement therapy for the “per os bisphosphonates”.
Recently I started having patients taking this yearly infusion and needing periodontal surgery, implants or extractions. Since there is no reports regarding complications or treating adjustments for these kind of patients- I was wondering whether any one of you can share his thoughts and/or experience ??
Zoledronic acid, the active ingredient of Aclasta, is also available under the trade-name Zometa® (zoledronic acid 4mg) for use in oncology indications, and we all know the complications related to this IV intake, especially regarding osteonecrosis of the jaws.

Views: 1549

Replies to This Discussion

Hi Coby,
I have asked one of our local physicians who is an expert on the topic to provide some insight for us. I'll get back to you ASAP. Regards.
Cary Feuerman, DMD said:
Hi Coby,
I have asked one of our local physicians who is an expert on the topic to provide some insight for us. I'll get back to you ASAP. Regards.
hi Cary---i am waiting with patience... thanks, cobi
Hi. I emailed him the other day. I'll check to see if he is around. Cary
OK Cobi. Here is his response:

"Hello Cary; see my inserts below. In the USA, it is called "Reclast" and is
given IV --- once a year (every other year if renal insufficiency is present).
It is over-marketed and very expensive. Giving a bisphosphonate this way solely
for "compliance" reasons doesn't justify the cost. We can track compliance by
pharmacy tracking of refills.

First, nobody here gives daily oral bisphosphonate Rx --- as mentioned by your
Israeli colleague. Fosamax (once/week) is now generic and very inexpensive.
Even a branded once/month pill would be lots cheaper than IV. We should use IV
bisphosphonates for osteoporosis Rx only if it is essential that the patient
gets bisphosphonate Rx and the pt. has an esophageal issue (like achalasia) or
has gastric intolerability.

Unfortunately, both pts. and docs are being seduced by marketing and the docs
can make $$$ by charging for an in-office IV infusion. Hence, we are seeing more
and more inappropriate use.

RE: ONJ of the jaw, I heard a presentation (at the Atlanta meetings last month)
by a great speaker from Houston (an endocrinologist and a lawyer) who associates
w/ MD Anderson cancer hosp. and who has a huge data bank. The occurance w/ oral
agents continues to be very small --- < 0.001% in pts. who don't already have a
"rotten mouth". High dose IV Rx for metastatic cancer runs a higher risk ---
as per data given to you before.

What about lower dose IV Rx --- such as Reclast?
His impression is that it really isn't sig. higher than w/ the oral Rx. Thus,
same care and concerns, but not to the magnitude we see w/ metastatic cancer IV
use. In short, no new changes in basic oral protocol needed.

OK, hope that helps......... /// Larry"
Hi Carry,
Many thanks to you and to Larry for the comprehensive reply.
I understand the message ...and i appreciate much Larry's attitude although i am not exactly the professional to judge...
But certainly i will keep my eyes open!!
However, it is still not clear to me what would be the suggested "protocol" regarding a "real" patient that had already been administered Reclast a half a year ago, and i have to extract her two upper molars?? should i wait another 3-4-5-6 months considering those teeth are advancely involved with periodontitis...???

Cary Feuerman, DMD said:
OK Cobi. Here is his response:

"Hello Cary; see my inserts below. In the USA, it is called "Reclast" and is
given IV --- once a year (every other year if renal insufficiency is present).
It is over-marketed and very expensive. Giving a bisphosphonate this way solely
for "compliance" reasons doesn't justify the cost. We can track compliance by
pharmacy tracking of refills.

First, nobody here gives daily oral bisphosphonate Rx --- as mentioned by your
Israeli colleague. Fosamax (once/week) is now generic and very inexpensive.
Even a branded once/month pill would be lots cheaper than IV. We should use IV
bisphosphonates for osteoporosis Rx only if it is essential that the patient
gets bisphosphonate Rx and the pt. has an esophageal issue (like achalasia) or
has gastric intolerability.

Unfortunately, both pts. and docs are being seduced by marketing and the docs
can make $$$ by charging for an in-office IV infusion. Hence, we are seeing more
and more inappropriate use.

RE: ONJ of the jaw, I heard a presentation (at the Atlanta meetings last month)
by a great speaker from Houston (an endocrinologist and a lawyer) who associates
w/ MD Anderson cancer hosp. and who has a huge data bank. The occurance w/ oral
agents continues to be very small --- < 0.001% in pts. who don't already have a
"rotten mouth". High dose IV Rx for metastatic cancer runs a higher risk ---
as per data given to you before.

What about lower dose IV Rx --- such as Reclast?
His impression is that it really isn't sig. higher than w/ the oral Rx. Thus,
same care and concerns, but not to the magnitude we see w/ metastatic cancer IV
use. In short, no new changes in basic oral protocol needed.

OK, hope that helps......... /// Larry"

RSS

WebDental Facebook Fan Page

Latest Activity

Umesh Chauhan left a comment for Stephen A Hassler
"Be Happy"
35 minutes ago
Umesh Chauhan left a comment for Dr. James Schwarz
"Be Happy"
36 minutes ago
Profile IconStephen A Hassler and Dr. James Schwarz joined WebDental
10 hours ago
Marielaina Perrone DDS posted a blog post

Why Are Early Orthodontic Evaluations Necessary?

In the past, orthodontics was routinely an early teen event that began once all of the baby teeth were gone and permanent teeth were in. Recent advances in the understanding of a child development as well as modern materials have re-evaluated the time for …See More
Monday
Jerry Das commented on Dr Rajnish Anand's blog post What Are Common Bad Breath Causes?
"Brushing and flossing teeth are extremely important to your oral hygiene and overall health. If you have chronic bad breath, you must visit a dentist to understand the issue. Use a good mouthwash right after brush & floss. Make sure…"
Monday
Randy Pigg is attending Andrew Sykes's event
Thumbnail

I.V. Sedation Training for Dentists - Houston, TX at Houston, TX

September 5, 2014 at 8am to September 21, 2014 at 5pm
Parenteral Sedation DentistryWe are providing IV dental sedation training for dentist nationally. This IV sedation dentistry course is a  comprehensive "mini-residency" and includes a minimum of 60 hours of didactic / classroom education and direct participation in administering IV sedation to  20 - 30  clinical dental cases while being observed. Advanced training in airway management and medical emergencies included. Total CE credits will be approximately 100 hours.This course is designed to…See More
Sunday
Kat K2 posted a blog post

Buy Dental Supplies Products Online at K2 Dental And Medical

K2 Dental and Medical is redefining how dentists purchase supplies and equipment for their practices. Through our state-of-the art online experience, we offer a complete selection of the newest dental equipment and supplies on the market. In record time and with the click of a mouse, you can get your dental instruments, tools, lab equipment and everything else you need for your busy practice. Our manufacturers include…See More
Saturday
José Ignacio Hernández Alonso updated their profile
Jul 18

© 2014   Created by WebDental.

Badges  |  Report an Issue  |  Terms of Service