Return to Got Bones?
July 28, 2006
FVFG on LH: Avascular Necrosis of the Hip
With osteonecrosis (also called avascular necrosis) being so much in the news because of the link between Fosamax and jaw osteonecrosis and Floyd Landis having osteonecrosis of the hip, I thought I'd direct anyone who's interested in the subject to a blog in the Health Diaries archives called FVFG on LH. (those acronyms stand for "Free Vascular Fibula Graft on Left Hip") Star wrote a lot about her hip surgeries and the challenges that someone dealing with avascular necrosis of the hip has to live with.
July 25, 2006
Floyd Landis Wins Despite Osteonecrosis of the Hip
Floyd Landis has amazed everyone by winning the Tour de France despite suffering from osteonecrosis of the hip. Landis sustained a femoral neck fracture of the hip during a car accident in 2003. This kind of fracture often leads to osteonecrosis (also called avascular necrosis) because the blood supply is cut off from the hip joint. If the blood can't get through, the result is osteonecrosis or "bone death" and eventual collapse of the joint.
Landis didn't make his osteonecrosis public until halfway through the Tour de France. He plans to undergo hip replacement surgery in California next month.
"It's really sad," Landis said, "if [my cycling career] is over now. This is what I've been doing a long time. But I can say that, having won the Tour, I'm a little more calm about it, for some reason. As long as there aren't any complications in surgery, I think by next spring, I'll be back racing, though probably not at this fitness level."
Landis says he's been "kind of racing every race like it's the last one" because of his osteonecrosis. If only we could all live each day like that.
July 8, 2006
Causes of Osteonecrosis
Dr. Paul Donahue answers a question about osteonecrosis or bone death. He explains what it is and gives various causes.
"The causes of osteonecrosis are many. People with sickle cell disease can get it. So do those who have lupus or gout. Pregnancy can bring it on. Cigarette smoking and heavy alcohol use have been implicated. A hip fracture or hip dislocation can lead to it. For many, no cause is ever found."
(Twin Cities Pioneer Press)
July 2, 2006
Dr. Peter Gott on Fosamax
Dr. Peter Gott, a well-known doctor, syndicated newspaper columnist and author, is advising his patients not to take Fosamax, Boniva, or Actonel:
" ... they – especially Fosamax – can cause a serious side effect called mandibular necrosis, or decay of the jawbone. Consequently, I have encouraged my patients to stop taking these drugs and have been searching for an appropriate substitute." (spokesmanreview.com)
Update: The above link no longer appears to be working.
June 29, 2006
Pamela Hines Has Osteonecrosis of the Jaw
Pamela Hines is a 52 year old woman who was taking Fosamax and is suing Merck. She was diagnosed with osteonecrosis of the jaw last year after having a tooth extracted.
"For Hines, the aftermath has been devastating. Now unemployed, she receives an intravenous antibiotic - ironically made by Merck - to help clear the infection in her mouth. She also undergoes hyperbaric treatment five days a week." (sltrib.com)
June 24, 2006
Bisphosphonate-Associated Jaw Disease
Here is an article that gives the estimated half life of bisphosphonates, and factors unique to the oral cavity that may be linked to early manifestation of osteonecrosis in the mouth.
"In order to adequately caution our patients, we need to acknowledge that we are dealing with a condition characterized by a long latency period. That means that the pharmacologic effects of the oral bisphosphonates may not be seen for years, so now is the time to educate our patients."
"There is no current effective treatment for ONJ, even after the medication is withdrawn. Jaw reconstructive surgery, surgical debridements, hyperbaric oxygen therapy, reconstruction with plates, reconstruction with bone, antibiotic therapy, and other treatments have not been completely effective at eradicating the progression of necrotic bone." (biz.yahoo.com)
June 11, 2006
Dr. Rosenfeld on Fosamax
Dr. Isadore Rosenfeld has a show on Fox News on Sunday mornings called Ask the Doctor. I usually tape it so I can listen later, and on April 23rd, shortly after the Fosamax lawsuits stories were published, someone asked the following question. Here is his answer:
Should people stop taking Fosamax?
“It’s very important to take Fosamax. Don’t let these headlines deter you. However, you should know, if you’re taking Fosamax, and you have a dental problem—you go to the dentist and he has to extract a tooth—that exposes a piece of the jawline which in women who take Fosamax can become infected, and when that bone becomes infected it can rot, and so on, and collapse. So what you need to remember is not to stop Fosamax—continue your Fosamax if your doctor has prescribed it—but if you go to the dentist tell the dentist and he or she may have to give you antibiotics and keep a close eye on the site of the extraction or sometimes they may decide not to do an extraction and maybe do a root canal instead. So it’s something you ought to discuss with your dentist. I’m so concerned because so many of my patients have been calling and saying, ‘Listen, should I stop Fosamax?’ The answer is no.”
So he says don't stop Fosamax, just remember to tell your dentist you're on it so he can be very very careful to not do anything that could cause your jaw to rot. I just find this answer to be incomprehensible. Would Dr. Rosenfeld risk taking Fosamax if he knew there was ANY possibility of his own jaw disentegrating? I can't believe that he would. As all the people on these drugs get older the odds are pretty good they are going to need some dental work that could put them at risk for osteonecrosis. So take this pill and wonder for the rest of your life what might happen if you need some dental work?? Don't let the headlines deter you? Dr. Rosenfeld, I enjoy listening to you, but I just do not understand this reasoning.
As I wrote in a previous post, Stella Poe said if she had been warned of the risks she wouldn't have taken Fosamax. I find it hard to believe that anyone would.
June 8, 2006
Stella Poe Wouldn't Have Taken It
Stella Poe is one of dozens of women who took Fosamax and is suing Merck, the maker of Fosamax. She took it for eight years and now has no teeth and no bone in her jaw. "If there was a warning, I wouldn't have taken it. ... I wouldn't have taken it," she said.
"When Poe began taking Fosamax, her attorney says there was no mention of ONJ under the warning label. In 2005, the FDA requested Merck include that in their warning. It has been there ever since, but patients like Poe say they were never told". (MySA.com)
June 7, 2006
Known Risk Factors for Osteonecrosis of the Jaw
As I mentioned in my blog, (Is It Hot in Here?), I have osteoporosis and a doctor a few years ago got very mad at me when I said for the third time I didn't want to take Fosamax. She said, "I have talked to you until I'm blue in the face..." and then walked out. At the time, I just sat on the table in stunned silence. Needless to say, I never went back.
I knew it was something I didn't want to do. My mother had terrible esophagus problems at the same time she was dying from breast cancer. We didn't connect it to the Fosamax then. Obviously there were much worse problems to deal with. She just kept saying there was something wrong when she swallowed. But I do know that the doctors were still telling her to take it while she was in bed, and that can lead to problems. She also was in excrutiating bone pain. Was that from the Fosamax or the cancer? We'll never know.
Now that all of these news stories and lawsuits have surfaced about the side effects of Fosamax and other bisphosponates I am so thankful I never took it. I can't imagine having to wonder if something might happen to my jaw if I ever have to have some kind of oral surgery. The National Osteoporosis Foundation estimates that 8 million women have osteoporosis and 22 million have low bone mass and are at risk of developing the disease. I keep thinking about the women who have taken these drugs and I worry what the future is going to bring. There must still be doctors who are prescribing these drugs without advising of the possible side effects. I think patients have a right to decide for themselves, after receiving all the facts, if they want to take the chance of their jaw disintegrating.
From the Fosamax website: Prescribing information was "For Healthcare Professionals". The site didn't prevent me from accessing the information, but why not just say it's for everyone? Why wouldn't this information be for the patient? Don't we have a right to see ALL the side effects and to be informed? Apparently not.
Here is some of what I found:
"In post marketing experience, severe and occasionally incapacitating bone, joint, and/or muscle pain has been reported in patients taking bisphosphonates that are approved for the prevention and treatment of osteoporosis (see ADVERSE REACTIONS). However, such reports have been infrequent. This category of drugs includes FOSAMAX (alendronate). Most of the patients were postmenopausal women. The time to onset of symptoms varied from one day to several months after starting the drug. Most patients had relief of symptoms after stopping. A subset had recurrence of symptoms when rechallenged with the same drug or another bisphosphonate. In placebo-controlled clinical studies of FOSAMAX, the percentages of patients with these symptoms were similar in the FOSAMAX and placebo groups."
"Osteonecrosis of the jaw, generally associated with tooth extraction and/or local infection, often with delayed healing, has been reported in patients taking bisphosphonates. Most reported cases of bisphosphonate-associated osteonecrosis have been in cancer patients treated with intravenous bisphosphonates, but some have occurred in patients with postmenopausal osteoporosis. Known risk factors for osteonecrosis include a diagnosis of cancer, concomitant therapies (e.g., chemotherapy, radiotherapy, corticosteroids), poor oral hygiene, and co-morbid disorders (e.g., pre-existing dental disease, anemia, coagulopathy, infection). Patients who develop osteonecrosis of the jaw (ONJ) while on bisphosphonate therapy should receive care by an oral surgeon. Dental surgery may exacerbate the condition. For patients requiring dental procedures, there are no data available to suggest whether discontinuation of bisphosphonate treatment reduces the risk for ONJ. Clinical judgment of the treating physician should guide the management plan of each patient based on individual benefit/risk assessment."
I love the "known risk factors for osteonecrosis" part. Seems to me that taking Fosamax should be a known risk factor.