Posts Tagged ‘Osteoporosis medication’
Dentists and Oral Surgeons are sometimes wary of their patients being on ANY Osteoporosis Medications when they undergo tooth extractions or other dental proceedures. One osteoporosis medication is different from all the others. Forteo is the only Anabolic medication currently available in the USA. Forteo does not cause dental and jaw problems. Forteo can be used to treat ONJ and other bone problems of the jaw.
OsteoNecrosis of the Jaw (ONJ) is a rare complication of tooth extraction. If you have cancer, are on chemotherapy, have uncontrolled diabetes, or are on the higher doses of Antiresorptive Osteoporosis Medications used in Cancer Patients with Metastases, ONJ is less rare.
ONJ is the result of too slow bone repair by the OsteoBlasts (the cells that make new bone matrix). Antiresorptive medications slow down both OsteoClasts (the cells that resorb bone) and OsteoBlasts.
Forteo cannot cause ONJ. Forteo (Teriparatide) stimulates OsteoBlasts. That increases new bone matrix formation. Therefore, Forteo can prevent and treat ONJ.
Forteo has been shown to improve bone healing in dental surgery, including implant osseointegration and healing alveolar defects. Ref: Batshutski JD, Eber RM, Kinney JS, et al. Teriparatide and osseous regeneration in the oral cavity. N Engl J Med. 2010, 363:2396-2405. Ref: Kuchler U, Luvizuto ER, Tangl S, et al. Short-term Teriparatide delivery and osseointegration: a clinical feasibility study. J Dent R. 2011:90(8):1001-1006.
As a former orthopedic surgeon, I have discussed these issues with several of our local oral surgeons and dentists.
If you are facing oral surgery or tooth extraction, discuss your osteoporosis medications with your dental surgeon. Most osteoporosis medications should be held for your surgery. Forteo is the exception. Forteo actually helps your jaw heal after dental surgery.
Jay Ginther, MD
Several patients have concerns about oral surgery while taking Prolia. This is not a problem – if you follow guidelines.
Prolia is different from other Antiresorptives. Prolia does not accumulate in bone. 5 to 6 months after your last dose, Prolia has lost its effect of slowing bone turnover. Therefore, it is safe to proceed with surgery on bone (including dental surgery) 6 months after your last dose.
Patients worry about OsteoNecrosis of the Jaw (ONJ), but this is very rare. In fact ONJ virtually never occurs without a tooth extraction or serious periodontal disease. Even then, it is rare unless you also have cancer, have poorly controlled diabetes, or are seriously Deficient in Vitamin D3, or Calcium, or Protein intake.
Elective Orthopedic Surgery timing is the same. If you need a Total Hip Replacement (THR) or Total Knee Replacement (TKR), schedule the surgery for 6 months after your last dose of Prolia.
Any time you plan to have surgery on bone, you should Optimize Your Bone Health First. Get a Complete Bone Health Evaluation. Optimize your Vitamin D level (at 40 to 80 ng/ml). Optimize your Calcium intake in foods and supplements combined (at 400 to 500 mg at all 3 meals daily). Optimize your daily Protein intake (1 g Protein for every kg body weight).
Sometimes you will also need the Anabolic, Forteo, to increase bone matrix and improve healing. More about that another time.
Get the best possible result from orthopedic or dental surgery. Wait 6 months after Prolia, and do your part to optimize your bone health.
Jay Ginther, MD
Protein is necessary for strong bone and muscle. Two patients complained that they were gaining weight when they added enough Protein for good bone health to their diets.
That was their problem. They ADDED Protein to a diet that already had enough Calories in Fats and Carbs. The key is to add Protein without adding Calories. This is harder than it sounds. You may have to reduce other foods to avoid a gain in Calories.
Proteins and Carbs are about equal in Calories. Fats are packed with twice as many Calories. Getting enough Protein as a Vegetarian or Vegan is challenging, but feasible.
Remember that the ideal weight for bone health is a BMI between 22 and 33. The ideal weight to AVOID Death From All Causes is a BMI between 25 and 30 if you are over 60 years of age. A BMI between 22 and 25 almost as good.
Many of our patients Take Control Naturally by getting enough absorbable Calcium in Foods, Vitamin D3, Protein in Foods, Multiple Vitamins & Minerals, and Exercises for Balance and Strength. This way they can often avoid medications for several years.
Take Control Naturally with enough Protein in a balanced diet.
Jay Ginther, MD
Fracture Prevention was the theme at NOF (National Osteoporosis Foundation) this year. This has always been their goal, but it has not been well communicated.
Fractures are bad. Fractures are painful. They keep you from doing things you want to do. For weeks. Or months. Or even forever.
Fractures ruin your finances. They cost a lot to treat. They cost even more if you cannot work.
Fractures can disable you temporarily, or even permanently. You can lose your Independence. You could spend the rest of your life in a Nursing Home.
Clinical Osteoporosis is an Increased Risk of Fracture.
One fracture doubles your risk of a second. Two fractures increases the risk 5 times. Fracture Risk is multiplied 9 times by 3 fractures.
You can decrease Fracture Risk. A Complete Bone Health Evaluation will identify nutrition and lifestyle details that you can improve for better Bone Health.
Many Fractures can be prevented by simple non-medication measures. You can start with proper Calcium, Vitamin D3, Protein, Balance and Strengthening Exercises, Multiple Vitamins & Minerals. These measures are necessary even if you also take osteoporosis medications. Often they are enough, at least for a few years.
Take Control of your Future. Prevent Fractures and all the misery they can bring.
Jay Ginther, MD