Osteoporosis and Osteonecrosis of the Jaws: An underestimated problem with multiple ramifications.

Article published in the New Zealand Health Charter Journal Spring 2006 / Summer 2007

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Osteonecrosis of the Jaw

E-article originally published October 2006 on Wikipedia

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Introduction to Through-transmission Alveolar Ultrasonography (TAU) in Dental Medicine

Published April 2005 by Cranio - The Journal of Craniomandibular Practice

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Osteoporosis is a major New Zealand health issue. It affects more that half of women and nearly a third of men over the age of 60. Oral osteoporosis is significantly associated with the peripheral skeleton and has been linked with oral infections, such as gum diseases, and heart / vascular diseases. Oral infections increase the risk of abnormal clotting which can cause impaired blood flow leading to a wide range of health problems. Poor blood flow in bone tissue can impair bone repair and regeneration through lack of oxygen and nutrients required by bone cells ( osteoblasts ) responsible for new bone matrix formation. Toxins such as heavy metals and acetaldehyde can impair bone regeneration.

Hormonal imbalances can also play a role in osteoporosis. Hormone replacement therapy has been associated with an increase in veinous clots ( thromboembolisms ) which can certainly impair blood flow. Numerous man-made petrochemicals in our environment have oestrogen-like properties ( xeno-oestrogens ) that have the ability to disrupt sex hormones receptors, thus disrupting the delicate balance between bone formation and bone resorption.

The role of a healthy liver should not be underestimated as the liver is responsible for the formation of good cholesterol which is used for the production of sex hormones precursors. The role of a healthy gut should not be underestimated since it is not only necessary for nutrients absorption but also for toxic waste elimination. A healthy liver depends on a healthy gut.

Bisphosphonates, a class of drugs widely used for the treatment of osteoporosis, has been implicated in jaw osteonecrosis. This class of drugs include Fosamax, Actonel, Boniva, Bonefos, Didronel, Aredia, Skelid and Zometa. Since 2001, more than 2,400 patients taking these bone medications have reported jaw bone death. Most of these reports came from people who took potent, intravenously delivered versions of these drugs. Officially the mechanism(s) involved in the association between osteoporosis, bisphosphonates and jaw osteonecrosis are poorly understood. However bisphosphonates are drugs that block bone resorption by inhibiting osteoclasts ( bone cells that resorb bone tissue ). While this prevents loss of mineral bone density it also prevents the body from resorbing diseased/damaged bone tissue, a natural process allowing bone to maintain healthy bone density through remodelling i.e removal of damaged bone and replacement with new healthy bone. See Fosamax does more harm than good.

Osteonecrosis is a bone disease associated with blood clots in the internal portion of bones ( bone infarcts ) causing ischaemia. It can be found in many bones, including the head of the femur, knee, shoulder, hands and jaws. Osteonecrosis is estimated to afflict 10,000 to 20,000 new patients each year in the United States alone. In general medicine controversy surrounds the choice of methods of diagnosis and treatment of osteonecrosis. In dental medicine the situation is even more controversial and even less understood. This in part reflects the needs for larger clinical studies and additional basic laboratory research.

Osteoporosis is not just an "old people's disease". Young people with low bone density can get osteoporosis too.

• More than 3,000 New Zealanders break a hip each year. This figure is expected to rise to 4,800 in ten years time as our population ages

• About a third of people who fracture a hip die within a year from related complications. Another third never return home. Many who do lose their mobility and independence.

• More women are hospitalised with a hip fracture due to osteoporosis than through breast cancer.

Osteoporosis is a widespread public health problem. The costs to national healthcare systems from osteoporosis-related hospitalization are staggering. For example, in several European countries, osteoporosis is responsible for more hospital days for women over 45 than any other disease. In the next 50 years, the number of hip fractures for both men and women will more than double. And hip fractures are just the tip of the iceberg.

Even so, osteoporosis was not precisely defined as a disease until 1994. The World Health Organization (WHO) has since identified osteoporosis as a priority health issue along with other major non-communicable diseases. Still systemic osteoporosis, including oral osteoporosis, is frequently not diagnosed and even less frequently treated. Ask our staff how to prevent, detect or treat oral osteoporosisor call for a consultation with Dr. Jacques Imbeau. An ounce of prevention is worth a pound of cure .....