Alendronate (Fosamax) and Risedronate (Actonel) Revisited:

Closure of an open wound associated with bisphosphonate-related osteonecrosis of the jaw in a breast cancer patient

BACKGROUND AND OBJECTIVE

Many clinicians will not treat patients presenting with bisphosphonate-related osteonecrosis of the jaw following long-term use of bisphosphonates because of the lack of predictable outcomes. MATERICAL AND METHODS: The patient presented with pain from a nonhealing lesion in the posterior maxilla following extraction of the maxillary right third molar. The lesion had not responded to any conventional dental treatment. The patient had suffered from breast cancer, and her treatment included several years of therapy with Zometa (zoledronic acid), a bisphosphonate.

RESULTS

The patient stopped taking Zometa and commenced rinsing with phosphate buffer-stabilized 0.1% chlorine dioxide-containing mouthwash. After 5 months, changes in the morphology of the lesion were noted and the soft tissue had closed over the open wound.

CONCLUSION

Cessation of bisphosphonate therapy and usage of a phosphate buffer-stabilized 0.1% chlorine dioxide-containing mouthwash lessened the patient's pain and resulted in closure of the soft tissue lesion.

Telephone counseling to improve osteoporosis treatment adherence: an effectiveness study in community practice settings

Treatment nonadherence is a recognized problem, but most practice settings use education alone to address it. Psychological counseling methods generate greater behavior change but are not widely used. Telehealth nursing can be used to integrate these methods into routine clinical practice. This study was a nonrandomized trial of a telehealth program that used motivational interviewing and cognitive- behavioral techniques to improve osteoporosis medication adherence. Registered nurses delivered the intervention to 402 participants recruited from provider offices across the United States. Initial participation rates were high in this community-based sample, although attrition also was high. Six-month adherence based on pharmacy and clinical interview data was significantly higher than the general population rate. A comparison with nonparticipants approached significance, and there was a significant dose-response effect. Most reasons given for nonadherence were psychological. The results support the use of psychological techniques to improve adherence and the use of telehealth to disseminate evidence-based patient counseling.