Is Fosamax (alendronate) a contraindication for patients with a mandibular mass, such as odontogenic fibromyxoma?

From the Guidelines

Fosamax (alendronate) is not specifically contraindicated for patients with a mandibular mass such as odontogenic fibromyxoma, but caution is warranted due to the risk of medication-related osteonecrosis of the jaw (MRONJ). Before starting Fosamax in these patients, a thorough dental evaluation and appropriate treatment of the mandibular mass should be completed, as recommended by the MASCC/ISOO/ASCO clinical practice guideline 1. Fosamax belongs to the bisphosphonate class of medications which carries a risk of MRONJ, particularly following invasive dental procedures. For patients with odontogenic fibromyxoma who require surgical intervention, it would be prudent to either delay starting Fosamax until after surgical recovery or temporarily discontinue the medication before surgery (typically 2-3 months prior) if already taking it, as suggested by the guidelines for the use of adjuvant bisphosphonates and other bone-modifying agents in breast cancer 1.

Some key considerations for managing patients with odontogenic fibromyxoma who are taking or will be taking Fosamax include:

• A dental assessment is recommended prior to commencement of bisphosphonates, and any pending dental or oral health problems should be dealt with prior to starting treatment, if possible 1
• Patients should be informed of the risk of developing ONJ, especially with tooth extractions and other invasive dental procedures 1
• Patients should inform their dental practitioner of their treatment, and patients with suspected ONJ should be referred to a dental practitioner with expertise in treating this condition 1
• Calcium and vitamin D supplementation is recommended unless otherwise contraindicated, and oral bisphosphonates and calcium should not be taken concurrently 1

The concern stems from bisphosphonates' mechanism of action - they inhibit osteoclast activity and bone resorption, which can impair normal bone healing following dental surgery. This risk is higher with intravenous bisphosphonates but still exists with oral formulations like Fosamax, especially with longer duration of use. Patients should maintain excellent oral hygiene and undergo regular dental check-ups while on Fosamax therapy to minimize complications.

From the Research

Fosamax Contraindication for Mandibular Mass

• Fosamax, also known as alendronate, is a bisphosphonate used to treat osteoporosis and other bone diseases 2.
• Bisphosphonates have been associated with osteonecrosis of the jaw, a condition characterized by necrotic bone exposure in the jaw 2, 3, 4.
• The incidence of bisphosphonate-related osteonecrosis of the jaw is low, but it can be a significant complication of bisphosphonate treatment 2.
• Odontogenic fibromyxoma is a rare, benign tumor that can occur in the jaw, and its treatment may involve surgical procedures 5, 6.
• There is no direct evidence to suggest that Fosamax is a contraindication for patients with a mandibular mass, such as odontogenic fibromyxoma.
• However, patients with bisphosphonate-associated osteonecrosis of the jaw may require special consideration and management to avoid exacerbating the condition 4.
• Surgical procedures, including those for odontogenic fibromyxoma, may need to be carefully planned and executed to minimize the risk of complications in patients taking Fosamax 3, 4.

Key Considerations

• The risk of osteonecrosis of the jaw associated with bisphosphonate use, particularly with alendronate 2, 3.
• The need for careful management and planning of surgical procedures in patients taking Fosamax 3, 4.
• The importance of distinguishing odontogenic fibromyxoma from other conditions that may require different treatment approaches 5, 6.