IMPLANT DENTISTRY / VOLUME 23, NUMBER 3 2014
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Editorial Prescribing Drugs: Is Anyone Listening? e have all heard physicians, when prescribing drugs, say that “they all have side effects.” This is usually mentioned (when it is mentioned) in an off-handed manner. It may be said as casually as “if you have an erection that lasts for 4 hours, see your physician immediately.” Well, colleagues, there are much more serious and potentially more destructive side effects of many drugs that affect both sexes. Bisphosphonates, though commonly prescribed for the treatment of osteoporosis, have the dubious distinction of having the potential to cause drug-induced osteonecrosis of the jaws (DIONJ). Dr. Robert E. Marx wrote an editorial in this journal, titled “Evasion of the Body Snatchers.”1 That was in 2009! Yet, his message apparently fell on deaf ears. He was forthright in his admonishment of named drug companies “because they evade responsibility and accountability for the cases of bisphosphonate-induced osteonecrosis of the jaws their drugs have caused.” That well-referenced, short but powerful, piece is worthwhile reading today. It should be mandatory reading for dental students and clinicians alike. As Dr. Marx stated, “The dental profession has inherited the complications of a medical therapy.” Let us fast forward to 2014. We are confronted with an accumulation of the same problems, sequelae, and destructiveness, including a rather blasé attitude. The drug companies appear to not be listening; and we are afraid that the profession itself, our profession, is being hoodwinked. The destruction persists. On VuMedi, February 2014, Dr. Marx, with Dr. Broumand and Dr. Armantanos, gave an audience participatory webinar, a candid exchange on oral and intravenous bisphosphonates and subcutaneous Denosumab.2 And, as if this subject requires reinforcement, which it apparently does, Drs. Robert Marx and Richard Kraut presented an allday subject-focused forum in New York, April 26, 2014, on Osteonecrosis of the Jaws, Bisphosphonates and RANK-L Inhibitors (Denosumab).
W
ISSN 1056-6163/14/02303-231 Implant Dentistry Volume 23 Number 3 Copyright © 2014 by Lippincott Williams & Wilkins DOI: 10.1097/ID.0000000000000132
The picture is not too bright for the treatment of osteoporosis. According to a publication by Dr. Susan Brown,3 she states that “While there may be serious bone density gains while using Forteo (Eli Lily), the research is clear that these gains are lost once the drug is stopped. To maintain bone density gains, antiresorptive drugs such as Fosamax (Merck Co.) must be used after stopping Forteo.” In other words, we are in a drug-induced vicious cycle. Forteo works (by injection) to increase bone formation and the “other” drugs work to halt bone breakdown. In addition to the warnings by these respected authorities on bone metabolism, there are periodic anecdotal clinical reminders in the literature. An example is an article published in this issue of Implant Dentistry.4 Its title says it all: “Bisphosphonate-Related Osteonecrosis Associated with Dental Implants: A Microcomputed Tomography Study.” It is eye, and mind, opening. We are sure that there will be more such cases reported and some that will not be documented in the literature. Nonetheless, we, as dentists, must contend with the silt that is left at the bottom of the drug bottle. After all, drugs have side effects, some of which beg to question: Can the cure be worse than the disease? Yes, it may!
Morton L. Perel, DDS, MScD Editor-in-Chief, IMPLANT DENTISTRY
REFERENCES 1. Marx RE. Evasion of the body snatchers. Implant Dent. 2009;18:371–372. 2. Marx RE, Broumand V, Armentanos L. Osteonecrosis of the jaws: Oral and intravenous bisphosphonates and subcutaneous denosumab. VuMedi. 2014. 3. Brown SE. Forteo: Is this drug too good to be true? Available at: http://www.betterbones.com/osteoporosis/ forteo-bonedrug.aspx. 4. Junquera L, Pelaz A, Gallego L, et al. Bisphosphonaterelated osteonecrosis associated with dental implants: A micro-computed tomography study. Implant Dent. 2014; 23:258–264.
231
Editorial Prescribing Drugs: Is Anyone Listening? e have all heard physicians, when prescribing drugs, say that “they all have side effects.” This is usually mentioned (when it is mentioned) in an off-handed manner. It may be said as casually as “if you have an erection that lasts for 4 hours, see your physician immediately.” Well, colleagues, there are much more serious and potentially more destructive side effects of many drugs that affect both sexes. Bisphosphonates, though commonly prescribed for the treatment of osteoporosis, have the dubious distinction of having the potential to cause drug-induced osteonecrosis of the jaws (DIONJ). Dr. Robert E. Marx wrote an editorial in this journal, titled “Evasion of the Body Snatchers.”1 That was in 2009! Yet, his message apparently fell on deaf ears. He was forthright in his admonishment of named drug companies “because they evade responsibility and accountability for the cases of bisphosphonate-induced osteonecrosis of the jaws their drugs have caused.” That well-referenced, short but powerful, piece is worthwhile reading today. It should be mandatory reading for dental students and clinicians alike. As Dr. Marx stated, “The dental profession has inherited the complications of a medical therapy.” Let us fast forward to 2014. We are confronted with an accumulation of the same problems, sequelae, and destructiveness, including a rather blasé attitude. The drug companies appear to not be listening; and we are afraid that the profession itself, our profession, is being hoodwinked. The destruction persists. On VuMedi, February 2014, Dr. Marx, with Dr. Broumand and Dr. Armantanos, gave an audience participatory webinar, a candid exchange on oral and intravenous bisphosphonates and subcutaneous Denosumab.2 And, as if this subject requires reinforcement, which it apparently does, Drs. Robert Marx and Richard Kraut presented an allday subject-focused forum in New York, April 26, 2014, on Osteonecrosis of the Jaws, Bisphosphonates and RANK-L Inhibitors (Denosumab).
W
ISSN 1056-6163/14/02303-231 Implant Dentistry Volume 23 Number 3 Copyright © 2014 by Lippincott Williams & Wilkins DOI: 10.1097/ID.0000000000000132
The picture is not too bright for the treatment of osteoporosis. According to a publication by Dr. Susan Brown,3 she states that “While there may be serious bone density gains while using Forteo (Eli Lily), the research is clear that these gains are lost once the drug is stopped. To maintain bone density gains, antiresorptive drugs such as Fosamax (Merck Co.) must be used after stopping Forteo.” In other words, we are in a drug-induced vicious cycle. Forteo works (by injection) to increase bone formation and the “other” drugs work to halt bone breakdown. In addition to the warnings by these respected authorities on bone metabolism, there are periodic anecdotal clinical reminders in the literature. An example is an article published in this issue of Implant Dentistry.4 Its title says it all: “Bisphosphonate-Related Osteonecrosis Associated with Dental Implants: A Microcomputed Tomography Study.” It is eye, and mind, opening. We are sure that there will be more such cases reported and some that will not be documented in the literature. Nonetheless, we, as dentists, must contend with the silt that is left at the bottom of the drug bottle. After all, drugs have side effects, some of which beg to question: Can the cure be worse than the disease? Yes, it may!
Morton L. Perel, DDS, MScD Editor-in-Chief, IMPLANT DENTISTRY
REFERENCES 1. Marx RE. Evasion of the body snatchers. Implant Dent. 2009;18:371–372. 2. Marx RE, Broumand V, Armentanos L. Osteonecrosis of the jaws: Oral and intravenous bisphosphonates and subcutaneous denosumab. VuMedi. 2014. 3. Brown SE. Forteo: Is this drug too good to be true? Available at: http://www.betterbones.com/osteoporosis/ forteo-bonedrug.aspx. 4. Junquera L, Pelaz A, Gallego L, et al. Bisphosphonaterelated osteonecrosis associated with dental implants: A micro-computed tomography study. Implant Dent. 2014; 23:258–264.
