Can BP patients take alcohol?

Bisphosphonate therapies

Bisphosphonates for osteoporosis therapy

Bisphosphonates (BP) inhibit bone breakdown and thereby maintain bone structure and strength. BP are therefore often used to treat benign bone diseases such as osteoporosis and Paget's disease.

Large clinical studies show that bisphosphonate therapy in osteoporosis based on calcium and vitamin D therapy causes an approximately 50% reduction in the risk of bone fractures (especially vertebral fractures) after a 3-year treatment period.

Rarely, in around 1: 10,000 to 1: 100,000 osteoporosis patients, what is known as jaw necrosis is observed during BP therapy. These changes, which are rare in osteoporosis patients taking bisphosphonates, arise on the basis of a pre-existing chronic inflammatory change in the tooth and jaw area, usually with apical or marginal periodontitis, with tooth root residues or denture pressure points or as a result of inadequate dental and oral care. These changes can occur more frequently in patients with diabetes mellitus or with additional long-term glucocorticoid therapy (= long-term cortisone treatment). As with any patient, an annual routine dental check-up is recommended for patients with osteoporosis. Bisphosphonate treatment in osteoporosis patients is not an obstacle to dental care, including necessary tooth extractions or the application of dental implants, provided that the usual oral hygiene requirements and recommendations are observed.


Bisphosphonates for bone metastases, bone tumors or multiple myeloma

In BP therapy for tumor-related bone lesions (bone metastases) and tumor osteolysis, significantly higher bisphosphonate concentrations and shorter treatment intervals (usually monthly) are used in comparison to BP therapy in osteoporosis patients. In these cases, BP inhibit the tumor-related increased bone resorption, which reduces or prevents the occurrence of bone fractures or increased serum calcium levels (hypercalcaemia). Clinical studies have also shown that BP reduce the size and recurrence of bone lesions, e.g. in breast cancer or multiple myeloma, after a treatment period of usually 2 years.

In tumor patients treated in this way, on the basis of the tumor disease and the necessary tumor therapy, the resulting often reduced immune system and occasionally also inadequate oral hygiene or with pre-existing inflammatory changes to the tooth support system, so-called BP-associated occurrences occur in 1-10% of the patients Necrosis of the jaw (= bone areas in the jaw area not covered by the oral mucosa without a tendency to heal over 8 weeks) Therefore, a dental clean-up is strongly recommended to all tumor patients before starting BP treatment. Dental implants are contraindicated in these patients. If jaw necrosis occurs in these tumor patients under bisphosphonate treatment, a dental-maxillofacial consultation should take place; Tooth extractions are to be avoided (e.g. root canal treatment instead) and an optimization of oral hygiene, possibly also antibiotic treatment, should be carried out in consultation. The continuation of bisphosphonate treatment has to be re-assessed haemato-oncologically.

Other possible risk factors for the occurrence of jaw necrosis in these patients should be eliminated or at least reduced (alcohol and nicotine, immunosuppressive e.g. glucocorticoid or chemotherapeutic treatments, intraoral trauma such as tooth extraction wounds or periodontal treatments and oral mucosal lesions e.g. due to insufficient prosthesis fit).

Dental check-ups are recommended at least once a year for tumor patients on BP therapy. Pain in the jaw area or painless lesions (e.g. aphthous ulcers or intraoral bone exposure without covering of the mucous membrane) should always be clarified by a dental or maxillofacial surgeon immediately.

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Osteological-endocrinological outpatient clinic

Tel .: 06221 / 56-8787

Contact Person

Prof. Dr. med. Dr. med. dent. Christian Kasperk
Head of the Osteology Section

Medical University Clinic Heidelberg
Internal Medicine I: Clinic for Endocrinology, Metabolism and Clinical Chemistry
In Neuenheimer Feld 410
69120 Heidelberg