Comments on: Bisphosphonate Side Effects and a New Clinical Trial http://www.psa-rising.com/blog/2009/01/bisphosphonates/ Sun, 24 Jul 2011 02:15:46 +0000 hourly 1 http://wordpress.org/?v=3.2.1 By: admin http://www.psa-rising.com/blog/2009/01/bisphosphonates/comment-page-1/#comment-517 admin Tue, 30 Nov 2010 18:06:46 +0000 http://www.psa-rising.com/blog/?p=890#comment-517 Basing your conclusion on one house-guest is unwise. And bear in mind we are especially concerned here with effects on men with prostate cancer or anyone with cancer. Studies of osteonecrosis of the jaw (ONJ) and bisphosphonates typically measure correlated factors including smoking and alcohol abuse. Conclusions distinguish between causes and variables. This is not to say that ONJ is never associated with certain types of tobacco use (and alcolohol abuse). But evidence so far indictaes a real connection between ONJ and bisphosphonate use. To avoid this patients without cancer are being advised by some dentists to come off bisphosphonates every 3 years. For a recent finding of a connection between ONJ and bisphosphonates in cancer patients--a study which found no link with smoking-- see: J Clin Oncol. 2009 Nov 10;27(32):5356-62. Epub 2009 Oct 5. Longitudinal cohort study of risk factors in cancer patients of bisphosphonate-related osteonecrosis of the jaw. http://www.ncbi.nlm.nih.gov/pubmed/19805682 621 patients who received 29,006 intravenous doses of BP, given monthly. Crude ONJ incidence was 8.5%, 3.1%, and 4.9% in patients with multiple myeloma, breast cancer, and prostate cancer, respectively. Patients with breast cancer demonstrated a reduced risk for ONJ development, which turned out to be nonsignificant after adjustment for other variables. Multivariate analysis demonstrated that use of dentures (aOR = 2.02; 95% CI, 1.03 to 3.96), history of dental extraction (aOR = 32.97; 95% CI, 18.02 to 60.31), having ever received zoledronate (aOR = 28.09; 95% CI, 5.74 to 137.43), and each zoledronate dose (aOR = 2.02; 95% CI, 1.15 to 3.56) were associated with increased risk for ONJ development. Smoking, periodontitis, and root canal treatment did not increase risk for ONJ in patients receiving BP. Basing your conclusion on one house-guest is unwise. And bear in mind we are especially concerned here with effects on men with prostate cancer or anyone with cancer. Studies of osteonecrosis of the jaw (ONJ) and bisphosphonates typically measure correlated factors including smoking and alcohol abuse. Conclusions distinguish between causes and variables. This is not to say that ONJ is never associated with certain types of tobacco use (and alcolohol abuse). But evidence so far indictaes a real connection between ONJ and bisphosphonate use. To avoid this patients without cancer are being advised by some dentists to come off bisphosphonates every 3 years.

For a recent finding of a connection between ONJ and bisphosphonates in cancer patients–a study which found no link with smoking– see:
J Clin Oncol. 2009 Nov 10;27(32):5356-62. Epub 2009 Oct 5.
Longitudinal cohort study of risk factors in cancer patients of bisphosphonate-related osteonecrosis of the jaw.
http://www.ncbi.nlm.nih.gov/pubmed/19805682

621 patients who received 29,006 intravenous doses of BP, given monthly. Crude ONJ incidence was 8.5%, 3.1%, and 4.9% in patients with multiple myeloma, breast cancer, and prostate cancer, respectively. Patients with breast cancer demonstrated a reduced risk for ONJ development, which turned out to be nonsignificant after adjustment for other variables. Multivariate analysis demonstrated that use of dentures (aOR = 2.02; 95% CI, 1.03 to 3.96), history of dental extraction (aOR = 32.97; 95% CI, 18.02 to 60.31), having ever received zoledronate (aOR = 28.09; 95% CI, 5.74 to 137.43), and each zoledronate dose (aOR = 2.02; 95% CI, 1.15 to 3.56) were associated with increased risk for ONJ development. Smoking, periodontitis, and root canal treatment did not increase risk for ONJ in patients receiving BP.

]]> By: Ozijim http://www.psa-rising.com/blog/2009/01/bisphosphonates/comment-page-1/#comment-512 Ozijim Mon, 22 Nov 2010 11:35:16 +0000 http://www.psa-rising.com/blog/?p=890#comment-512 Have a house guest who claims jaw necrosis. Heavy smoker! On checking that out, smoking looks like a risk factor up there with the intravenous dose regime for bisphosphonates. Strange that esophageal cancer is also a product of smoking. Perhaps there is a simpler explanation for these cases than the coincidental use of bisphosphonates. How many of the 23 cases were neither active smokers nor passive smokers? Have a house guest who claims jaw necrosis. Heavy smoker! On checking that out, smoking looks like a risk factor up there with the intravenous dose regime for bisphosphonates. Strange that esophageal cancer is also a product of smoking. Perhaps there is a simpler explanation for these cases than the coincidental use of bisphosphonates. How many of the 23 cases were neither active smokers nor passive smokers?

]]> By: searoemer http://www.psa-rising.com/blog/2009/01/bisphosphonates/comment-page-1/#comment-84 searoemer Thu, 01 Jan 2009 13:51:29 +0000 http://www.psa-rising.com/blog/?p=890#comment-84 I faced the possibility of jaw necrosis. Several months ago I panicked when I had to have a tooth removed and the oral surgeon (MD/DDS) told me that he was scared and that his malpractice provider wanted to make sure my informed consent was more "informed" then normally required for an extraction. I called Rugerio and two oncologists at Harvard who study BRONJ. They helped me and the dental surgeon relax enough so that I went ahead with the extraction. So far so good--no jaw problem. The take away message from all this drama was no one really knows the etiology of the problem. Therefore it is very difficult to find an answer. It seems to me that if a drug alters the remodeling of the bone the risk of jaw necrosis remains on the table. RHUP20 may make bisphosphonates more palatable for people who fear esophageal cancer but it will make the drug company and doctors even happier because injections are given in doctor's offices, pills are taken at home, and infusions are given in hospitals. The docs are being squeezed by HMO and Medicare so they need a way to get people coming into the office. Pills and infusions don't cut it. Zometa (about 2 thousand dollars per injection) goes generic fairly soon. Fosamax has received bad press. If I were on the lawyer/marketing team I would want a replacement drug in the pipeline to keep the income flowing. I don't think my reasoning is cynical. This is the way we work together to solve problems. Medicine is in the marketplace and it is there to stay. As long as we blindly hope for Dr Welby to start caring for us again we won’t be able to address our broken health care system. I faced the possibility of jaw necrosis.

Several months ago I panicked when I had to have a tooth removed and the oral surgeon (MD/DDS) told me that he was scared and that his malpractice provider wanted to make sure my informed consent was more “informed” then normally required for an extraction.

I called Rugerio and two oncologists at Harvard who study BRONJ. They helped me and the dental surgeon relax enough so that I went ahead with the extraction.
So far so good–no jaw problem.

The take away message from all this drama was no one really knows the etiology
of the problem. Therefore it is very difficult to find an answer. It seems to me that if a drug alters the remodeling of the bone the risk of jaw necrosis remains on the table.

RHUP20 may make bisphosphonates more palatable for people who fear esophageal cancer but it will make the drug company and doctors even happier because injections are given in doctor’s offices, pills are taken at home, and infusions are given in hospitals. The docs are being squeezed by HMO and Medicare so they need a way to get people coming into the office. Pills and infusions don’t cut it.

Zometa (about 2 thousand dollars per injection) goes generic fairly soon. Fosamax has received bad press. If I were on the lawyer/marketing team I would want a replacement drug in the pipeline to keep the income flowing.

I don’t think my reasoning is cynical. This is the way we work together to solve problems. Medicine is in the marketplace and it is there to stay. As long as we blindly hope for Dr Welby to start caring for us again we won’t be able to address our broken health care system.

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