Almost 5 million Italians suffer from osteoporosis, 2 out of 3 cases are women, and every year they suffer about 600,000 bone fractures, often followed by loss of autonomy and hospitalizations, for a cost of almost 10 billion. However, this condition is underdiagnosed and undertreated: 80% receive inadequate care and 1 in 2 patients abandon therapy for fear of possible side effects, including damage to the jaw bones. But cures for brittle bones and healthy gums can go hand in hand. The first Guidelines on the use of antifracture drugs in patients with periodontitis, developed by the Italian Society of Periodontology and Implantology (Siidp) and the Italian Society of Orthopedics and Traumatology (Siot), shed light and reassured patients.
The work was born as part of the ‘Healthy Bone Healthy Gums’ project and will be presented at the XXI Sidp National Congress, scheduled from 9 to 11 March at the Palacongressi in Rimini.
“The introduction of these therapies has constituted an important step forward in the prevention of fractures – says Luca Landi, coordinator of the Guidelines for Sidp – but a certain concern has arisen in patients when one of the possible complications of taking anti-resorptives is osteonecrosis of the jaws has appeared.It is a degeneration of a portion of bone – he explains – which can become exposed, spontaneously or following dental treatment, and which does not heal and can cause pain, swelling and ulceration of the soft tissues up to the mobility with severe impairment of masticatory function”.
Its incidence, he continues, “is very low and ranges from less than 0.5% in the case of therapy for osteoporosis and up to approximately 8% in the case of use for oncological reasons. But we are increasingly witnessing the fears of patients treated with these drugs or who should start taking them.Suspending or not starting the therapy, for fear of incurring this complication, not only exposes the patient to a higher risk of fracture – underlines the expert – but often determines a difficulties for the dentist who has to manage dental extractions or surgery in patients with periodontal problems.For this reason, the Position Paper ‘Healthy Bone Healthy Gums’ underlines the importance of anti-fracture therapy which must not be interrupted or postponed by the dentist unless this is done in agreement with the prescriber”.
“Osteoporosis – says Maria Luisa Brandi, coordinator of the Guidelines for Siot and head of the Observatory for fragility fractures – is a systemic skeletal disease characterized by a reduction in bone mass and quality which leads to bone fragility and a greater risk of fractures of the hip, spine, humerus, forearm.In Italy over 4.5 million people, 2 out of 3 women, suffer from it and, in the next 25 years, the percentage of the over 65 population affected will increase by 25%.Today there are powerful drugs for the prevention of fragility fractures.Adequate anti-resorptive therapy can reduce fractures by 50% with a positive impact, not only on patients’ health and quality of life, but also on spending However, as many as 80% of patients with osteoporosis do not receive adequate treatment and 1 in 2 patients abandon therapy”.
The joint Sidp and Siot document focuses, for the first time, on the possible implications of anti-resorptive therapy in osteoporotic patients at high risk of fracture in those affected by periodontitis and gingivitis. “We have set up a task force of experts from the two disciplines – says Sforza – to create a useful consensus for clinicians and patients. Despite the low incidence of complications for the jaw bone encountered with the use of these drugs, in fact, it is necessary attention in the case of patients suffering from periodontitis, a gum disease that destroys the supporting tissue of the teeth and, in the most serious cases, causes them to fall.The elements to take into consideration are the dosage of the drugs, the route of administration , the duration of therapy, the presence of concomitant pathologies and the conditions of the oral cavity”.
In particular, for those taking bone medications, the main risk of jaw osteonecrosis occurs in the case of tooth extractions. “It is necessary – explains Landi – to be very careful in tackling surgical procedures in these patients: the initial clinical evaluation alone is not sufficient, but it is necessary to start periodontal treatment and reevaluate the health conditions after some time. However, the The chance of developing jaw necrosis in patients with successfully treated periodontitis is much lower than the risk of fragility fractures in high-risk people.On the other hand, periodontal therapy is effective in reducing the risk of tooth extraction and tooth placement. implants. The latter are not contraindicated in patients with osteoporosis but should only be used after controlling periodontal inflammation”.
“Among the indications – concludes Landi – there is that of evaluating the oral and periodontal conditions before starting a therapy based on drugs for the bones and to keep the gingival inflammation under control”.
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