Collaboration between prescribing physicians and dentists in oral bisphosphonate treatment

Abstract

Oral bisphosphonate（“oral BP drugs”）are extremely effective for osteoporosis. On the other hand, osteonecrosis of the jaw induced by oral BP drugs is a growing problem among dentists. A full understanding of both the usefulness of oral BP drugs as well as their side effects can be thought of as the starting point in treatment with oral BP drugs for collaboration between prescribing physicians（primarily orthopedic surgeons）and dentists. The problems in the context of collaboration are summarized, what sort of collaboration is considered possible at present and the prospects for further collaboration in the future are mentioned. The following three points are current important problems :（1）The incidence of osteonecrosis of the jaw induced by oral BP drugs surveyed by Westerners, whose oral environment is different from that of the Japanese, is used domestically ;（2）There are differing views concerning dental treatment between the Medicine and Dentistry joint position paper on osteonecrosis of the jaw and the revised addendum by the Ministry of Health, Labour and Welfare ;（3） There is insufficient understanding of the jawbone in which necrosis has occurred. Building smooth collaboration is the first step to resolving these problems. As for （1）, I believe that a large‒scale co‒ordinated medical and dental survey is necessary to clarify the domestic incidence of osteonecrosis of the jaw. As for（2）, a coalition of various societies such as the Japan Osteoporosis Society and the Japanese Society of Oral and Maxillofacial Surgeons recommend that the wording in the revised addendum concerning dental treatment should be changed to be consistent with the position paper. As for（3）, further dental research is required. Considering a practical means of collaboration at present, it is important that we should build wide‒ranging cooperative relationships that include pharmacists and pharmaceutical companies as well as prescribing physicians and dentists. This would contribute to the provision of accurate information concerning the prevention of osteonecrosis of the jaw for all osteoporosis patients, and patients, prescribers and dentists would all be able to benefit from preventative dental treatment through active dentist visits. Maintaining a healthy oral environment and uninterrupted administration of oral BP drugs in all osteoporosis patients would reduce the risk of osteonecrosis of the jaw and systemic fractures, and these measures would improve the quality of life through maintenance of ADL and mastication capability. Prescribing orthopedic surgeons and dentists should collaborate to protect bone health throughout the body and it is thought that these professions contribute most to healthy life in the elderly. We should proudly take part in the prevention and treatment of osteonecrosis of the jaw induced by oral BP drugs.