X-rays help predict jawbone damage from bisphosphonates

Oncologists and dentists are now using x-rays to detect ‘ghost sockets' in breast cancer patients that take bisphosphonates, which have been found to place people at risk for developing osteonecrosis of the jaws--early detection of these ghost sockets can help avoid permanent damage to the  jawbone of these patients, according to research in the March/April issue of General Dentistry.

Breast cancer patients, individuals at risk for osteoporosis and those undergoing certain types of bone cancer therapies often take drugs containing bisphosphonates. A ghost socket occurs when the jawbone is not healing and repairing itself the right way.

"The good news is that even though these ghost sockets may occur, by using radiographic techniques we can see that the soft tissue above these sockets can still heal," according to lead author Kishore Shetty, DDS, associate professor of restorative dentistry and diagnostic sciences at the University of Texas Dental Branch at Houston. Shetty said that the findings are "important news" because early prevention and detection can halt permanent damage from happening to a patient's jawbone.

In 2006, about 191 million prescriptions of oral bisphosphonates worldwide were written. The National Osteoporosis Foundation estimates that nearly 44 million people in the United States are at risk for developing osteoporosis. Currently, approximately 10 million Americans suffer from the disease.

Bisphosphonates are a family of drugs used to prevent and treat osteoporosis, multiple myeloma, Paget's disease (bone cancers), and bone metastasis from other cancers. The drugs can bond to bone surfaces and prevent osteoclasts (cells that break down bone) from doing their job. Other cells are still working trying to form bone, but it may turn out to be less healthy bone leading to the ghost-like appearance on x-rays.

"Healthy bones can easily regenerate," Shetty said. "But, because jawbones have rapid cell turnover, they can fail to heal properly in patients taking any of the bisphosphonate drugs. It's very important for patients to know about complications from dental surgery or extractions. Since these drugs linger in the bone indefinitely, they may upset the cell balance in how the jaws regenerate and remove unhealthy bone."

According to Academy of General Dentistry (AGD) spokesperson Carolyn Taggart-Burns, DDS, patients who are taking bisphosphonates should inform their dentist to prevent complications from dental surgical procedures.

"Widespread use of bisphosphonates to prevent or treat early osteoporosis in relatively young women and the likelihood of long-term use is a cause for concern," said Taggart-Burns.

Shetty and Taggart-Burns agreed that, "how bisphosphonates interfere with healing after dental surgery is still unclear and further research will be needed. It is imperative that the public understands there is no present treatment or cure for this problem."