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Warning over bisphosphonates ridiculed

Osteoporosis specialists have branded advice from the UK drug regulator to avoid dental treatment while on bisphosphonates as ‘ridiculous'.

The Medicines and Healthcare Products Regulatory Agency, in its Drug Safety Update this month, said invasive dental treatment should be avoided by many patients on bisphosphonates because of the risk of jaw osteonecrosis. Those with poor oral hygiene, cancer, and on chemotherapy or steroids are considered to be at high risk.

But Dr Pam Brown, a GP in Swansea and member of the primary care forum of the National Osteoporosis Society, said there was ‘no need' for dental checks for patients with osteoporosis receiving oral bisphosphonate therapy.

Dr Brown said the estimated risk of such patients developing osteonecrosis of the jaw was about one in 100,000 patient-years.

‘About 95% of cases of osteonecrosis of the jaw are in patients receiving intravenous bisphosphonates for multiple myeloma or metastatic bone disease, and the risk is extremely low with oral bisphosphonates for osteoporosis,' she said.

The new advice was branded ‘ridiculous' by Professor John Studd, consultant gynaecologist at the Chelsea and Westminster Hospital and vice-president of the National Osteoporosis Society.

‘It is a very rare complication in women having high doses of bisphosphonates,' said Professor Studd. He recommended giving women oestrogens before the age of 60 to prevent osteoporosis, as they were the cheapest and best-tolerated treatment.

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