Boniva or Fosamax???

It was my understanding that osteonecrosis of the jaw was irreversible. 

Tina

You certainly should be able to have your request taken seriously.  She is NOT too young to have these done.  How many YOUNG women get bc and their docs say, YOU ARE TOO YOUNG.  Insist on having the blood work done.

I thought that most people effected by jaw necrosis were one's who had cancer treatment.  I may be totally wrong.  And my dentist (who I don't believe..like I don't believe a lot of docs) says it's usually the shots (?) or is it intravenous (?) that causes the problems.

You could always get a second opinion.  She's too young to let her bones deteriorate more.  

Perhaps someone else will come along with another opinion.

Shirley

Calico and daughter, I am so sorry for this trouble. How simply unfair for her and you.



Four months of a bisphosphonate such as Boniva or Fosomax should be o.k. if your daughter has good healthy gums, and stays away from dental extractions such as wisdom teeth pulls.



I say this because many studies link poor gum health with the onset of osteonecrosis of the jaw. Not all, but many. IV Zolodex or Palmidrate is indeed associated with a higher rate (I think 4%) than oral (I seem to recall very low, like 0.3% or so).



The benefit, is it felt to help stabilize the loss of bone before the surgery, Calico? Or is it being suggested after surgery to help stabilize the new joint? Or is it sandwiched for both?



It's not a bad idea to check your daughter's kidney status, her creatinine and BUN on blood tests. These drugs do get excreted through the kidneys, so that's reasonable.



A good dental exam, cleaning before the use of the proposed new drug would cover her for the six months of a biyearly cleaning. And your dentist could see that no teeth are coming in sideways etc, prompting reconsideration.



It's just my opinion as a Mom of a teenager, yet I think I would go ahead if all systems were go, and fully understood why the orthopedist was recommending it, with using it should it help my daughters acceptance of a new hip, and ultimate function. But I truly understand how this weighs on you and wish you and she only the very best.



Tender

This sounds like what happened to me each month after my Neulasta shot!(Same type thing, in a way.Neulasta helps chemo patients keep their white cell count up.The drug encourages bones to form white cells.,And it does hurt like hell.)

Calico, I actually came to support you in this, and to say I'm very, very sorry that your young daughter has to be saddled with this.

I wish we could fast-forward to next New Year.Your daughter is through her Boniva tx, AND her hip resurfacing.It went perfectly, and she feels marvellous now.Just like every other 16 year old girl.And Happy Sweet 16!

Love,Joan

Calico--These seem to be among the more common side effects of Boniva---depending on the severity.  Could it be that that an adolescent would be more sensitive to that medication since

her bones are still growing?

(The pending revision regards possible atrial fibrillation (an abnormal heart rhythm))

--------------------------------------------------------------------------------------------------- 

What side effects can this medication cause?   

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

Ibandronate injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

    * stomach pain
    * nausea
    * constipation
    * diarrhea
    * heartburn
    * back pain
    * rash
    * bone, joint, or muscle pain
    * pain in the arms or legs
    * weakness
    * tiredness
    * dizziness
    * headache
    * fever, sore throat, chills, cough, and other signs of infection
    * frequent or urgent need to urinate
    * painful urination
    * redness, or swelling at injection spot

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately before receiving any more ibandronate injection:

    * painful or swollen gums
    * loosening of the teeth
    * numbness or heavy feeling in the jaw
    * poor healing of the jaw
    * eye pain or swelling
    * vision changes
    * sensitivity to light

Ibandronate injection may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

Calico,

Yes, palpitations, would be a symptom as could shortness of breath, lightheadedness and chest discomfort.

I think its really too early in the FDA's investigation to be alarmed about this.  It's still in the reporting stage----But, overwhelming pain,-- that is another matter and should  be reported and addressed---I'd be a squeaky wheel about that one! I'm so sorry.  I can't imagine watching your child in pain and unable to take it away.

  Maybe there is something she could take instead of Celebrex?

Sometimes specialists can be a bit myopic.  Do you have a Primary Care Physician for her?  One that is a family practice specialty (they take care of birth to death) If you do I would contact one of them and see if there is anything that may give her better pain coverage and make sure that the meds are age appropriate.

How much longer does she have to take the Boniva?

Calico--  I took a very bad fall

(actually 2 falls) --with a traumatic enough injuries to necessitate a shoulder replacement.  I had also dislocated my shoulder at the time and torn the rotator cuff in addition to multiple fractures---Unfortunately for me the Docs in the Emergency room didn't realize the extent of my injuries and tried to pull it back into the socket----The result was a Brachial Plexus Stretch and that trauma has caused a condition called Reflex Sympathetic Dystrophy (RSD) aka (CRPS)-----That began 4 and a half years ago.

  Pain has been a constant for me and pain control a balancing act.  I'm an ongoing medical experiment and have been on medications too numerous to count----You name it --I've been on it! The only thing I can't take are NSAIDS and COX2 inhibitors---because of a toxic auto-immune reaction I've had to them. Additionally I'm allergic to Sulfa.

Anyway,  What I wanted to suggest is that you may want to try the Traumeel ointment on her---Ask her orthopedist. It is a Homeopathic Analgesic. I have found that it can really break the pain cycle.  It works quickly and I find it really can make both the musculoskeletal and the nerve pain more manageable.

I do have heavy duty medications but the Traumeel keeps their use to a minimum if I catch the pain in time.  I feel so strongly about it that I now have three tubes.  I went into an absolute panic a few weeks ago when I lost my tube.  My pain levels were through the roof again. I promised myself that would not happen again.  So I now keep three on hand.

One, I keep by the bed.  I keep another in my pocketbook and a third in the living room. Before that I was getting a specially compounded ointment

composed of Gabapentin, Ketamine and Clonadine---The Traumeel works much better.It can be gotten at any Health food store but iherb.com really has much better prices.

Just thought it may be worth a try.  Your Orthopedist will probably just shake his head thinking its another crazy homeopathic--but I tell you the stuff works!  

I'm truly sorry that your daughter has so much to go through at such a young age.  I did not realize that your Orthopedist's practice had an adolescent population as well.  That makes all the difference.  

By the way, I was put on the Bisphosponates not because of the AI but because of the shoulder replacement issues.---It was my Orthopedist that put me on it. 

Thinking of you both

Calico- A year after the shoulder replacement I managed another fall resulting in some more very rare traumatic breaks in the same arm. The elbow this time.  I am metal woman! Distinguishing the bone pain from musculoskeletal and from neurological is difficult and at times they overlap.  One can set off another.

If you put your hand on any of my affected areas you can still feel the heat they are radiating, and the liver enzyme Alkaline Phosphatase always runs high as a result of this.

One thing with chronic pain that I find;  As you make one pain better you 

become more aware of others.  Still, it may give her some relief. -worth a try. 

My prayers are with you that your dear daughter can find some relief and this will all eventually be a distant memory. I know this is a long road and my heart goes out to you.

Love,

Susie

PS--Just alerting you of this from Medwatch today

FDA informed healthcare professionals and patients of the possibility of severe and sometimes incapacitating bone, joint, and/or muscle (musculoskeletal) pain in patients taking bisphosphonates. Although severe musculoskeletal pain is included in the prescribing information for all bisphosphonates, the association between bisphosphonates and severe musculoskeletal pain may be overlooked by healthcare professionals, delaying diagnosis, prolonging pain and/or impairment, and necessitating the use of analgesics. The severe musculoskeletal pain may occur within days, months, or years after starting a bisphosphonates. Some patients have reported complete relief of symptoms after discontinuing the bisphosphonate, whereas others have reported slow or incomplete resolution. The risk factors for and incidence of severe musculoskeletal pain associated with bisphosphonates are unknown.

Healthcare professionals should consider whether bisphosphonate use might be responsible for severe musculoskeletal pain in patients who present with these symptoms and consider temporary or permanent discontinuation of the drug.

Read the complete 2007 and 2008 MedWatch Safety Summary including a link to the FDA Drug Information Page regarding this issue at: http://www.fda.gov/medwatch/safety/2008/safety08.htm#Bisphosphonates