Bisphosphonates for Multiple Myeloma
Myeloma cells can dissolve, weaken, and even break bones. Drugs called bisphosphonates can help bones stay strong by slowing down this process.
The standard bisphosphonates for treating bone problems in people with myeloma are pamidronate (Aredia®) and zoledronic acid (Zometa®). These drugs are given intravenously (IV or into a vein). Most patients are treated once a month at first, but they may be able to be treated less often later on if they are doing well. Treatment with a bisphosphonate helps prevent further bone damage in multiple myeloma patients.
Bisphosphonate treatment does have a rare but serious side effect called osteonecrosis of the jaw (ONJ). Patients complain of pain and doctors find that part of the jaw bone has died. This can lead to an open sore that doesn’t heal. It can also lead to tooth loss in that area. The jaw bone can also become infected. Doctors aren’t sure why this happens or how best to prevent it, but having jaw surgery or having a tooth removed can trigger this problem. Avoid these procedures while you are taking a bisphosphonate. Many doctors recommend that patients have a dental checkup before starting treatment. That way, any dental problems can be taken care of before starting the drug. If ONJ does occur, the doctor will stop the bisphosphonate treatment.
One way to avoid these dental procedures is to maintain good oral hygiene by flossing, brushing, making sure that dentures fit properly, and having regular dental checkups. Any tooth or gum infections should be treated promptly. Dental fillings, root canal procedures, and tooth crowns do not seem to lead to ONJ.
Last Medical Review: May 22, 2014 Last Revised: January 19, 2016
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