Role of bisphosphonates in management of osteoporosis and its adverse effects on the jaw

Background: The efficacy of different types of bisphosphonates has already been established in the treatment of osteoporosis and some studies have also shown some correlation to its side effects on oral health. Aim and Objective: To determine the role of different bisphosphonate drugs (inhibitor osteoclast-mediated bone resorption) in the treatment osteoporosis and their adverse effects jaw under one study over a period of 24 months. Materials and Methods: This is a longitudinal study of selected patients and the changes were studied during follow-ups that were designed at 6, 9, 12, 24 months. Four groups (16 patients in each) were formed with patients undergoing treatment for osteoporosis and were administered different bisphosphonates group medicine (Alandronate- short acting; Ibandronate- medium acting; Zoledronic acid- long acting) and effects and side-effects on jaw were studied during follow-up. Results: After 2 years, the patients receiving bisphosphonates (groups A, B, C) had significant increase in their mean (±SE) spinal bone density (4.2 ± 0.8% and 5.2 ± 0.7%, respectively; P < 0.017). The rate of new vertebral fractures was reduced by half in the bisphosphonate-treated patients as compared with the patients who only received calcium and vitamin Db (group D) (29.5 vs. 62.9 fractures per 1,000 patient-years; P = 0.043); also there were seen osteonecrosis-like symptoms in jaw more in zoledronic-acid-using patients and as compared to oral bisphosphonates. Conclusion: Bisphosphonate therapy for 2 years significantly increases spinal bone mass and reduces the incidence of new vertebral fractures in osteoporotic patients, but also has risk factor for jaw bone necrosis associated with it.