oral surgery and Aclasta (or Reclast)

Replies to This Discussion

Permalink Reply by Cary Feuerman, DMD on November 5, 2009 at 2:47pm

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.

Permalink Reply by cobi landsberg on November 7, 2009 at 12:09pm

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.

Permalink Reply by cobi landsberg on November 7, 2009 at 12:10pm

hi Cary---i am waiting with patience... thanks, cobi

Permalink Reply by Cary Feuerman, DMD on November 7, 2009 at 1:12pm

Hi. I emailed him the other day. I'll check to see if he is around. Cary

Permalink Reply by Cary Feuerman, DMD on November 9, 2009 at 1:36pm

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"

Permalink Reply by cobi landsberg on November 10, 2009 at 1:34pm

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"