13. Rare in bisphosphonate doses used in OP
1:100,000
More common with IV bisphosphonates (but still rare)
14. • Discuss potential risks and symptoms with
patient
• Encourage good dental hygiene
• Pretreatment dental visit not necessary
15. • < 3yrs treatment with BP
• Dental extractions and implants as normal
• > 3 yrs treatment
• Stop BP for 3 months before treatment
• Restart when bone healed
30. After 5 years little to support continued
benefit on fracture risk
Possibility of drug holiday in some (low risk
pts)
Change to alternative agent
31.
32. Drug holiday?
• Patients with lower risk
• May stop for up to 2 years
• Possible small drop in BMD
• No increased risk of fracture
• Avoid in high risk patients
34. Summary
• Encourage Dietary Ca
• For most Single dose Ca supplement plenty
• Not essential to treat everybody!
• Use FRAX to help aid decision
• Monitor for Bone loss (2 yrs)
• Consider revise Bisphosphonates at 5-7yrs
• Consider Drug holiday