Osteonecrosis of the Jaw and Breast Cancer

Did you know that certain breast cancer treatments can increase the risk of osteonecrosis of the jaw? Though it is rare and only a small number of people will develop osteonecrosis of the jaw, it is a serious side effect. And since we believe in breast cancer education and the power of knowledge, let’s learn about osteonecrosis and its symptoms, stages, treatment, and management together.

Osteonecrosis

Osteonecrosis is the death of bone cells due to a decrease in blood flow, which may result in pain and, in more extreme circumstances, bone collapse. Studies have shown that osteonecrosis, exclusively in the jaw (ONJ), is a rare side effect that results from certain medications- bisphosphonates and denosumab. Such medications, like Zometa, are often prescribed to breast cancer patients to prevent bone loss or even metastasis to the bone. Radiation exposure in the jaw area and certain dental procedures can also cause ONJ.

Symptoms of Osteonecrosis of the Jaw

ONJ is identified by visible bone in the mouth. Varying levels of both pain and swelling in the mouth are the most common symptoms. Other symptoms include numbness in the mouth and loose teeth. In serious cases, infection of the jaw may also occur.

Stages of Osteonecrosis of the Jaw

Osteonecrosis of the jaw can be classified into three different stages. Exposed bone is present in all stages.

Stage 1: No symptoms

Stage 2: Pain, swelling, or infection of the jaw

Stage 3: Pathologic fracture, extra-oral fistula, or osteolysis (breakdown of bone tissue)

Osteonecrosis from Bisphosphonates

Because bone loss (osteoporosis) can occur in women receiving breast cancer treatment, they may be prescribed bisphosphonates. Bisphosphonates function to prevent bone loss and strengthen bones. A rare side effect of taking bisphosphonates is osteonecrosis, particularly in the jaw. The cause of bisphosphonate-related osteonecrosis is still unknown. Chemotherapy treatment while taking bisphosphonates is a risk factor of ONJ.

Treatment of Osteonecrosis of the Jaw

Fortunately, osteonecrosis of the jaw is often not life-threatening. ONJ can be treated with antibiotics, oral rinses, and dental treatments. In more severe stages of ONJ, surgical removal of the affected bone may be necessary. If taking bisphosphonates, make sure to inform your dentist, as certain surgical dental procedures can increase the severity of ONJ.

Can Osteonecrosis of the Jaw be Avoided?

Because osteonecrosis of the jaw is quite uncommon, definitive methods of preventing this side effect have not been developed. However, you can minimize your risk by informing your oncologist about any upcoming dental procedures, notifying your dentist that you will be taking bisphosphonates, and maintaining good oral hygiene.

Thank you for exploring jaw problems and cancer with us. For further study, please explore the sources listed below.

Do you have personal experience with osteonecrosis and breast cancer? We would love to hear from you! Submit your story to Desiree at dleroy@survivingbreastcancer.org to be featured on our blog and newsletter.

Sources:

• https://pubmed.ncbi.nlm.nih.gov/18422377/

• https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Osteonecrosis

• https://www.aafp.org/afp/2012/0615/p1134.html

• https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/symptoms-causes/syc-20369859

• https://www.mskcc.org/cancer-care/patient-education/osteonecrosis-jaw-onj

• https://www.researchgate.net/figure/Clinical-staging-osteonecrosis-of-the-jaw_tbl2_6674303

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