Actonel Osteonecrosis of the Jaw (ONJ)

Actonel osteonecrosis of the jawActonel is a drug used to treat bone loss caused by conditions such as osteoporosis, Paget’s disease of bone, and osteoporosis from menopause. It is a member of a class of drugs called bisphosphonates. Actonel works to alter the cycle that regulates the formation and breakdown of bone in the body. Research shows that Actonel and other bisphosphonates work to slow down a patient’s bone loss while increase the bone mass. As a result, fractures may be reduced. Actonel is manufactured by Warner Chilcott, which purchased the pharmaceuticals unit of manufacturing giant Procter & Gamble.

However, Actonel patients may experience severe side effects including osteonecrosis of the jaw (ONJ). Actonel osteonecrosis of the jaw is a rare yet devastating condition. Patients who develop severe cases of Actonel osteonecrosis of the jaw may experience a collapse of their jawbone. Other Actonel side effects include bladder cancer, bone fractures, low blood calcium, and esophageal ulcers and inflammation.

What Is Osteonecrosis of the Jaw?

Osteonecrosis of the jaw is a condition during which the jawbone starts to weaken and die. The term osteonecrosis literally translates to “bone death.” For this reason, osteonecrosis of the jaw is also known as “dead jaw syndrome.” The condition typically begins after the patient receives dental work of experiences other minor trauma in the mouth. When this trauma occurs, a lesion exposes an area of the patient’s gums.

Instead of healing, this area becomes infected. As a result of infection, the surrounding soft tissue erodes. Erosion causes a lack of proper blood flow to the area, which equates to a lack of proper blood flow to the jawbone itself. The jawbone essentially becomes starved from this inadequate blood supply. The American College of Rheumatology defines that osteonecrosis of the jaw is classified after a minimum of 8 weeks. The classification of each patient’s condition depends on the severity, the number of lesions present, and the size of the lesions.

Signs and Symptoms

The primary symptom of Actonel osteonecrosis of the jaw is the presence of lesions in the gums. This leads to the exposure of patient’s mandible or maxilla. The mandible is the jawbone, while the maxilla is the bone that creates the top part of the patient’s mouth. Patients who suffer Actonel osteonecrosis of the jaw will typically develop these lesions after dental procedures such as tooth extractions.

However, Actonel osteonecrosis of the jaw has also developed spontaneously. Patients with Actonel osteonecrosis of the jaw have reported no symptoms for weeks or months until they developed lesions that exposed bone. It is reported that Actonel osteonecrosis of the jaw occurs most commonly in the mandible than in the maxilla.

Symptoms of Actonel osteonecrosis of the jaw include:

  • Pain
  • Inflammation of the soft tissue
  • Secondary infection or drainage

Actonel Osteonecrosis of the Jaw Risk

Research indicates that patients who take bisphosphonates such as Actonel, Fosamax, and Boniva are more likely to develop osteonecrosis of the jaw. Patients may develop Actonel osteonecrosis of the jaw after as little as 12 months of taking Actonel and respective bisphosphonate drugs. The longer the drug is taken, the higher the chance of developing osteonecrosis of the jaw. The majority of Actonel osteonecrosis of the jaw cases occur in patients who received treatment for longer than 5 years.

The Actonel osteonecrosis of the jaw risk is higher in patients who receive bisphosphonate as a treatment for cancer. It is estimated that dosages of Actonel and other bisphosphonates can be as much as 10 times higher when used to treat cancer. Additionally, cancer patients often receive the drug intravenously as often as every month. Osteoporosis patients may only receive one IV dose per year.

View Sources
  1. "Osteonecrosis of the Jaw (ONJ)." American College of Rheumatology. American College of Rheumatology, n.d. Web. 19 May 2013.
  2. Pierson, Ransdell. "Warner Chilcott buying P&G unit for $3.1 billion." Reuters. Reuters, 24 Aug 2009. Web. 19 May 2013.
  3. Reinberg, Steven. "FDA to review safety of osteoporosis drugs." USA Today. N.p., 12 Sep 2011. Web. 19 May 2013.