Tag Archive for: RANK ligand inhibitors

Is There a Link Between Myeloma and Dental Health?

Is There a Link Between Myeloma and Dental Health? from Patient Empowerment Network on Vimeo.

Dr. Sikander Ailawadhi from Mayo Clinic explains that while multiple myeloma doesn’t commonly cause dental issues, there can be indirect connections via bone problems.

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Transcript:

Lisa Hatfield:

Another question from a patient since my diagnosis and bone marrow transplant, my teeth have been deteriorating, is there a connection between dental health and myeloma?

Dr. Sikander Ailawadhi:

Very important question because although this is not a very common finding, it is something that really affects quality of life, so myeloma itself does not always or frequently caused teeth problems or dentition problems, which you can imagine teeth are bones. Myeloma affects bones, Myeloma affects calcium deposition in bone so teeth can get damaged in two or three different ways in myeloma patients, first, if myeloma involves the job or you can imagine that the teeth in that particular area could become loose or they could become a little off because the structure is getting affected.

Sometimes if my novels present on the job, for example, and radiation is given, but that bone becomes weaker, so teeth can become weaker, another way myeloma and dental health can be connected is because we use certain bone-strengthening agents for myeloma. These drugs are called either bisphosphonates, for example, or zoledronic acid (Zometa) or pamidronate acid (Aredia), patients may know as Zometa or Aredia, or there’s a second category called RANK ligand inhibitors, one of the drugs there is denosumab or Xgeva, these are all drugs that are given for bone-strengthening for myeloma. Patients are recommended to take calcium and vitamin D, but a rare but definitive side effect that is known to happen or can happen with these drugs is what’s called osteonecrosis of the jaw, where basically the jaw bone is becoming necrosed or less viable.

And you can imagine if the jaw is less viable, the teeth that go into the jaw in that spot, they’ll become loose and hurt, painful…it’s not a good condition to have it very…it affects quality of life significantly. So while it is rare, this osteonecrosis of the jaw can occur maybe less than 10 percent of the cases, but it is a significant morbidity causing issue.

What I recommend to patients is that one, if that is happening, first of all, we’re not…we typically don’t continue that drug that is causing it, like a bisphosphonate or RANK ligand inhibitor. Secondly, the patient needs to see a good oral maxillofacial surgeon or a good dentist, preferably someone who has knowledge and experience in handling outreaches of the job. So different ways in which melodic treatment can affect the job, there is not a direct correlation, but in about 10 to 15 percent of cases, there may be care or death-related implications and monuments either from the disease or its treatment like radiation or bone-strengthening drugs. 

Bone-Building Therapies Recommended for Myeloma Patients

Bone-Building Therapies Recommended for Myeloma Patients from Patient Empowerment Network on Vimeo.

What can multiple myeloma patients do for bone-building therapies? Dr. Sikander Ailawadhi from the Mayo Clinic discusses bone-strengthening drugs and some physical activities to help with bone care.

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Transcript:

Lisa Hatfield: 

So if a patient cannot take bisphosphates doesn’t explain the reason why, are there other bone-building therapies that are recommended to protect them?

Dr. Sikander Ailawadhi: 

Sure, so I would say that while we talk about these drugs like bisphosphonates, RANK ligand inhibitors, there are some other drugs that can be used to strengthen the bones, because you can imagine these molesting agents are used in a lot of different cancer, breast cancer, prostate cancer, etcetera. So this family of drugs can be used, there are some that are used less frequently, but can be used instead of bisphosphonates and denosumab (Prolia), but I would bring the patients back to even more basic stuff, calcium, vitamin D, exercise, bone-strengthening exercise. These are the first steps.

Then come the other bone-modifying drugs, so even if a patient has been told that they cannot get any of those drugs because of the side effects, they could certainly say calcium, vitamin D after discussing with their doctors, and they can regularly do some bone-strengthening building exercises sometimes it’s as simple as swimming, as simple as spinning, but those are like on the stationary bike, but those are extremely important activities to help build bone mass. 

Lisa Hatfield:

All right, thank you. Have you ever had a patient that has reached complete response that you said, Well, maybe you don’t need to continue on bisphosphonates, that ever an option for patients to not continue after a certain period of time?

Dr. Sikander Ailawadhi:

Again, excellent question. And, in fact, historically, all the bisphosphonate-related clinical trials had up to a two-year follow-up, so a lot of times we used to say, “Well, at two years we need to stop them because there’s no safety data beyond that.” But more recently, there are studies that have shown that even every three months of bisphosphonates is as good as every month. So if somebody has active bone-affecting myeloma, then their treatment can be given every month or every three months.

But if a person has gone into remission, and remember, the myeloma was the exciting event that was causing the bone loss, if there is no disease, if there are no active ones and the person is in good health, they are active…no bone-related issues. You’ve done imaging. Everything is good. I think it certainly it can be done that bisphosphonate can be stopped. And, of course, this needs to be actively discussed with the patient, frankly, other than having the side effect concern, if I can have a patient not coming for the treatment and they can spend that much extra time with their family doing what they want to…I think that’s a win-win.