Treatment Could Prevent Patients With Cancer From Experiencing Jawbone Damage After Oral Surgery

Patients with cancer who receive high doses of bisphosphonates, used to treat bone cancer, can experience jaw damage. New preclinical research published in Bone Science Direct could prevent these patients from experiencing this loss of jawbone tissue after routine oral surgery.

Bisphosphonates bind to the jawbone, causing painful and chronic inflammation and infection leading to the loss of jawbone tissue, and they can remain bound to the bones for months or years after treatment. As of now, there is no known treatment or prevention for this side effect, which can be deadly.

In the new study, researchers from the University of California, Los Angeles (UCLA) and the University of Southern California were able to remove the bisphosphonates from the jawbone by injecting an inert bisphosphonates compound. Doing so displaced the bisphosphonate to the jawbone.

“When being treated for cancer, the infusion of the high dose bisphosphonate drug is an important tool to control bone pain and osteolysis in patients with cancers,” Ichiro Nishimura, DMD, DMSc, DDS, a professor of prosthodontics with the UCLA School of Dentistry and a member of the UCLA Jonsson Comprehensive Cancer Center, said in a statement. “These are cancers that originate in bone marrow, such as multiple myeloma, or that have metastasized to the skeleton, such as from breast and prostate cancers. The presence of this bisphosphonate represents a significant risk particularly following needed routine dental surgery.”

According to the researchers, the findings could mean preventing jawbone loss in patients treated with bisphosphonates while still allowing the drugs to remain bound to the rest of the skeleton. Removing the bisphosphonates from the jawbone clears the way for oral surgery.

The researchers previously studied nitrogen containing bisphosphonates in mouse models with bisphosphonate-related osteonecrosis of the jaw. In the new study, they examine the effect of using nitrogen containing bisphosphonates on tooth extraction wound healing.

“Our results are consistent with the hypothesis that local application of a rescue [bisphosphonates] prior to dental surgery can decrease the amount of a legacy [nitrogen containing bisphosphonates] drug in proximate jawbone surfaces below the threshold that promotes osteocyte necrosis,” the authors concluded.

Reference

Hokugo A, Kanayama K, Sun S, et al. Rescue bisphosphonate treatment of alveolar bone improves extraction socket healing and reduces osteonecrosis in zoledronate-treated mice. Bone. 2019;123:115-128. doi: 10.1016/j.bone.2019.03.027.