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Bisphosphonates and Osteonecrosis — the Bare Bones

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Prescriber Update 38(3): 47
September 2017

Key Messages

Osteonecrosis of the jaw has been associated with both oral and intravenous bisphosphonates.
Healthcare professionals should advise patients to maintain good oral hygiene, have routine dental check-ups and report any adverse oral symptoms immediately.
Osteonecrosis at other sites such as the hip, femur and auditory canal have also been reported with the use of some bisphosphonates.

Osteonecrosis of the Jaw

Healthcare professionals are reminded that osteonecrosis of the jaw (ONJ) has been associated with bisphosphonate treatment. All bisphosphonate data sheets include information on ONJ.

ONJ is predominantly reported in patients with cancer receiving treatment with intravenous bisphosphonates^1–3. Many of these patients were also receiving chemotherapy and corticosteroids^2,3.

ONJ has also been rarely reported with oral bisphosphonates¹. These cases were generally associated with tooth extraction and/or local infection with delayed healing¹.

Healthcare professionals should advise patients at risk of experiencing ONJ to maintain good oral hygiene, have routine dental check-ups and report any adverse oral symptoms immediately to their doctor and dentist^2,4.

From 1 January 2012 to 31 December 2016, the Centre for Adverse Reactions Monitoring (CARM) has received 14 case reports of ONJ where a bisphosphonate was considered to be the suspect medicine.

Further information on ONJ is available in a previous edition of Prescriber Update (www.medsafe.govt.nz/profs/PUArticles/OsteonecrosisJune2012.htm).

Osteonecrosis at Other Sites

More recently, osteonecrosis at other sites including the hip, femur and external auditory canal has been reported with the use of some bisphosphonates^1,2,5,6.

References

Merck Sharp & Dohme (New Zealand) Limited. 2015. Fosamax Data Sheet. 31 August 2015. URL: medsafe.govt.nz/profs/Datasheet/f/Fosamaxtab.pdf (accessed 21 June 2017)
Novartis New Zealand Limited.2016. Aclasta Data Sheet. 13 December 2016. URL: medsafe.govt.nz/profs/Datasheet/a/Aclastainf.pdf (accessed 21 June 2017).
Hospira NZ Limited. 2015. Pamisol Data Sheet. 3 June 2015. URL: medsafe.govt.nz/profs/Datasheet/p/Pamisolinj.pdf (accessed 21 June 2017).
Novartis New Zealand Limited. 2017. Aclasta Consumer Medicine Information. December 2016. URL: medsafe.govt.nz/Consumers/CMI/a/aclasta.pdf (accessed 27 June 2017).
Novartis New Zealand Limited. 2016. Zometa Data Sheet. 23 May 2016. URL: medsafe.govt.nz/profs/Datasheet/z/Zometaconcinf.pdf (accessed 27 June 2017).
Novartis New Zealand Limited. 2016. Risedronate Sandoz Data Sheet. 5 May 2016. URL: medsafe.govt.nz/profs/Datasheet/r/risedronatesandoztab.pdf (accessed 27 June 2017).