Side Effects of Bone Strengtheners: Multiple Myeloma

When I started taking a bone strengthener, also known as Zometa, could anyone have predicted that a fragment of my jawbone would detach itself from my mouth? As I was relishing a basic salad, I was stunned when I detected a small piece of bone mingling with the masticated pieces of fresh arugula, scallions and olives. A consultation with an oral surgeon clarified that this was a normal bodily function of expelling deceased bone matter.

In the previous year, I suffered from a tooth infection and it was evident that my lower left molar, "Tooth #18", needed extraction. The surgical removal took place in May 2022. Now, a vast gap exists between two of my back molars, reminiscent of the lions guarding the entrance to the Hong Kong and Shanghai Banking Corporate headquarters in Hong Kong. Typically, the gums would heal within a few weeks. However, having been diagnosed with multiple myeloma, the tissue recovery process was prolonged. I am thankful that the oral surgeon was well-informed about the state of the jawbone in relation to my special condition.

A close friend of mine is experiencing significant discomfort in her upper jaw, making eating a challenge. Her treatment uses denosumab (Prolia, Xgeva) for postmenopausal women with osteoporosis. She cannot even savor her beloved caramel candy. Moreover, intervention could potentially lead to inadequate bone healing. To alleviate the pain, oral rinses, antibiotics and pain relievers are suggested.

On the MM Support Facebook group, there are many people sharing their jaw experiences. One person posted “my teeth are getting hammered. I’ve broke 3 teeth (all in the back) since starting treatment.” Another person replied “Was on Zometa for 3-4 years and been off of it for 3-4 years…A couple molars have crumbled and had root canals and crowns! Dental insurance sucks and doesn’t pay much. The cost of all these repairs is killing me.”

Living with multiple myeloma often means maneuvering through a complicated labyrinth of treatments and medications. Zometa, a drug used to prevent skeletal issues in patients with certain cancer types, is one such remedy. It is also known as a class of bisphosphonates which function by decelerating the process of bone degradation. However, it can also result in a condition known as osteonecrosis of the jaw, where the jawbone begins to weaken and decay. This condition is typically linked with invasive dental procedures or treatments, but it can also occur spontaneously. In my situation, it appears that the long-term effects of this zoledronic acid may have potentially contributed to this unforeseen bone fragment.

This treatment protocol was administered to me as part of a clinical trial when I was initially diagnosed in 2017. I recall receiving it at regular intervals; I finished the treatments in November 2020, under the impression that its effects would terminate with the conclusion of the treatment. However, the oral surgeon enlightened me that Zometa could linger in the body for years, persistently impacting bone health.

A study published in the Journal of Clinical Oncology in 2007 shed light on the prolonged presence of bisphosphonates in the body for up to a decade after the last dosage. This extended duration can continue to affect bone metabolism, potentially resulting in complications like unexpected bone fractures or osteonecrosis, as observed in my case.

Another friend was prescribed an alendronate, commonly known by the brand name Fosamax, which is also a biphosphonate. It decreases the rate bone cells are absorbed. This reduced absorption allows the body to increase bone density, which in turn reduces the risk of fracture. After research, my friend decided not to take this medicine and chose to follow a natural approach. After a year or so, her condition considerably improved from osteoporosis to osteopenia.

This incident has prompted me to question the value of using Zometa for multiple myeloma. While it undeniably offers benefits, the potential long-term effects on bone health are worrisome. It becomes a delicate balance between managing the immediate risks of the disease and considering the consequences of the treatment. Although I cannot turn back time, it is important to ask questions until we understand and until the answer resonates with us.

My own encounter of discovering a fragment of my jawbone in a salad served as a vivid reminder of Zometa's enduring impact on bone health. While the drug plays a vital role in managing specific health issues, it's crucial to be cognizant of its potential long-term side effects, even years after stopping its use. This episode highlights the significance of routine medical examinations and transparent dialogue with healthcare professionals regarding previous overall physical conditions, to guarantee the best possible health management. After all, navigating through multiple myeloma isn't solely about survival, but also about thriving despite everything.

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