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FOR Launch Week OF JUNE 13, 2022 (COL. 4)
BYLINE: By Keith Roach, M.D.
TITLE: Jawbone death is a rare complication of osteoporosis meds
Expensive DR. ROACH: I am taking Fosamax for osteoporosis. 1 of the side outcomes is osteonecrosis of the jaw. Does this only happen if you have important dental perform, this sort of as pulling enamel or root canals, or can it transpire with schedule cleanings, fillings? — G.D.
Remedy: The word osteonecrosis virtually implies “bone dying,” so osteonecrosis of the jaw is a critical problem involving bad blood move that benefits in death of the bone cells in the jaw. It might have an impact on possibly the major portion (maxilla) or base (mandible).
ONJ can occur in individuals who are not using medications, in particular people today with specific circumstances such as having had radiation to the jaw or sickle mobile condition, but it is typically linked with some sorts of remedies employed to handle osteoporosis, such as the alendronate (Fosamax) you choose. It is a lot more widespread with intravenous drugs than with drugs.
Extra threat aspects contain steroid use (these kinds of as prednisone), lively most cancers, smoking, diabetes and pre-present dental ailment. On the other hand, dental extractions and implants also improve possibility of ONJ. Normal dental treatment, these as cleanings, most likely decreases the threat of ONJ by improving dental well being.
ONJ is not widespread in persons having oral drugs such as Fosamax. The estimate is that for a human being taking an oral bisphosphonate for five years, about 1 in 20,000 men and women will develop ONJ. That chance is drastically larger in persons with supplemental threat components, but continue to is only about 1 in 2,000 persons.
Most experts who use Fosamax and related prescription drugs will maintain off on managing individuals with these medications if they have dental perform these types of as extractions or implants planned. The hold off is commonly a number of months, right up until immediately after therapeutic of the jaw is entire.
Expensive DR. ROACH: I’m in my 60s and am noticing quite a few folks — typically females — with crossed toes. It seems unpleasant! Why really don’t their physicians send them to a podiatrist? Why do people today just let this go? It are unable to be revenue, mainly because quite a few of the folks who I see have loads of that! Could you enlighten me? I stay in a heat local weather, so I see plenty of toes. — C.D.
Answer: There are a lot of frequent deformities of the toe, which includes crossover toe, hammertoe, bunions and claw toe. Both equally men and gals get these, but females may possibly be extra probably to get them if they are putting their toes into pointy-toed, large-heeled shoes, which make a person’s ft far more vulnerable to tendon hurt.
I am going to wager many of the people you see have been to a podiatrist — at least, I hope so, simply because podiatrists are the industry experts on toes. But not each individual issue of the foot or toes desires surgery in get to be set. Correct footwear, orthotics, “buddy taping” a toe into position and making use of toe spacers all can help this ailment.
Far more superior circumstances will need further more remedy, often which include physical treatment or injection. Surgical procedures is regarded as only when significantly less invasive treatment plans have failed and the particular person carries on getting symptoms that are critical plenty of to make surgical procedures, with its attendant suffering, dangers, inconvenience and restoration time, worthwhile.
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Dr. Roach regrets that he is unable to response particular person letters, but will incorporate them in the column every time feasible. Visitors may perhaps email inquiries to [email protected] or send out mail to 628 Virginia Dr., Orlando, FL 32803.
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