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Article: Volume 43 Number 3 Page 235 - April 2016

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  Dent Update 2016; 43: 235-242

General Dental practice:  Relevance of Bisphosphonate Therapy in Osteoporosis and Cancer − No Cause for Alarm in Dentistry

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Abstract: This report provides important background information on osteoporosis (OP) and bone complications of cancer for the dental team, and discusses why bisphosphonate (BP) therapy is vital for patients with the two conditions. It also addresses several questions, including in particular: ‘Is withholding BP therapy the best way to prevent osteonecrosis of the jaw (ONJ) occurrence?’ Also, ‘Of the two, which is more important: ONJ or OP fracture prevention?’

Clinical relevance: BP therapy offers OP patients the promise of a fracture-free life and the prevention of fracture-related pain, disability, loss of qualify of life (QOL) and the shortening of life. Without BP therapy, the lifetime risk of fracture occurrence in OP patients is as high as 1 in 2 women and 1 in 5 men; whilst using it, the relative risk of ONJ occurrence is as low as between 1 in 10, 000 and 1 in 100, 000. To cancer patients with bone complications, it offers the much needed pain relief and improvement in QOL. In cancer patients, the risk of ONJ is almost 100 times higher but, despite that, oncologists advocate BP therapy for virtually all the patients. Therefore, when prescribed, BP therapy merits the whole-hearted support of the dental team.

Author notes: Amelia Elizabeth Moore, BSc, MSc, PhD, Research Fellow in Osteoporosis, King’s College London, Tara Renton, PhD, MDSc, BDS, FDS RCS FRACDS(OMS), FHEA, Professor of Oral Surgery, King’s College London, Hon Consultant King’s College Hospital Foundation Trust, Hon Consultant, Guy’s and St Thomas’ Foundation Trust, Talli Taylor, BDS(Orth), Aarhus, Specialist in Oral Surgery, King’s College Hospital, Shina Popat, MSurg Dent RCS(Eng), MFDS RCS(Eng) BDS(Lon), Specialist in Oral Surgery, King’s College Hospital and Mukundrai Kris Jasani, MBChB, FRCP, Research Physician in Osteoporosis, Guy’s and St Thomas’ NHS Trust, Hon Consultant in Metabolic Bone Diseases, Guy’s and St Thomas’ Foundation Trust, London, UK.

Objective: To highlight the merits of bisphosphonate therapy in offering much needed pain relief and improvement in quality of life.