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TO YOUR GOOD HEALTH #12345_20220616

FOR RELEASE WEEK OF JUNE 13, 2022 (COL. 4)

BY LINE: By Keith Roach, MD

TITLE: Jaw death is a rare complication of osteoporosis medications

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DEAR DR. ROACH: I take Fosamax for osteoporosis. One of the side effects is osteonecrosis of the jaw. Does this only happen if you have major dental work, such as tooth extraction or root canals, or can it happen with routine cleanings, fillings? –GD

ANSWER: The word osteonecrosis literally means “bone death”, so osteonecrosis of the jaw is a serious condition involving poor blood circulation that leads to the death of bone cells in the jaw. It can affect either the upper part (maxilla) or the lower part (mandible).

ONJ can occur in people who do not take medication, especially people with certain conditions such as radiation therapy to the jaw or sickle cell disease, but it is often associated with certain types of medications used to treat osteoporosis , such as alendronate (Fosamax) that you are taking. It is more common with intravenous medications than with pills.

Additional risk factors include steroid use (such as prednisone), active cancer, smoking, diabetes, and pre-existing dental disease. However, dental extractions and implants also increase the risk of ONJ. Regular dental care, such as cleanings, likely decreases the risk of ONJ by improving dental health.

ONJ is not common in people taking oral medications such as Fosamax. The estimate is that for a person taking an oral bisphosphonate for five years, about 1 in 20,000 people will develop ONJ. This risk is significantly higher in people with additional risk factors, but is still only about 1 in 2,000 people.

Most experts who use Fosamax and similar drugs will refrain from treating patients with these drugs if they have planned dental work such as extractions or implants. The delay is generally a few months, until the healing of the jawbone is complete.

DEAR DR. ROACH: I’m in my 60s and I notice a lot of people – mostly women – having their toes crossed. it looks painful! Why don’t their doctors send them to a podiatrist? Why do people give up? It can’t be money, because a lot of people I see have plenty of it! Could you enlighten me? I live in a hot climate, so I see a lot of feet. –CD

ANSWER: There are many common toe deformities including cross toe, hammer toe, bunions and claw toe. Both men and women get it, but women may be more susceptible to it if they put their feet in high-heeled, pointy-toed shoes, which make a person’s feet more prone to injury to the ankles. tendons.

I bet a lot of people you see have seen a podiatrist – at least I hope so, because podiatrists are the foot experts. But not all foot or toe problems require surgery to fix. Proper footwear, orthotics, a “buddy taping” a toe in place, and the use of toe spacers can all help with this condition.

More advanced cases require additional treatment, sometimes including physical therapy or injection. Surgery is only considered when less invasive treatments have failed and the person continues to have symptoms severe enough for surgery, with the accompanying pain, risks, inconvenience and recovery time. worth it.

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Dr Roach regrets that he cannot respond to individual letters, but will incorporate them into the column whenever possible. Readers can email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.

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