[hlpbParticipant]

Hi,

this is my first time on the forum and looking for some advice, please. My 76 year old mum was diagnosed with MM at Christmas, and is currently on her 4th month of treatment. She is responding very well, with pp levels down to 1.4 (whoop, whoop) Her consultant and trials nurse are very keen for her to start zometa as well, but the dentist from the hospital’s max.fac. department and mum’s dentist have put the fear of god into her about ONJ. She will need some dental work first and has some existing thinning of the jaw bone. We don’t feel well informed enough to make a decision, yet. Does anyone please have any advice or experiences to share? Thank you

 

[CarolsymonsParticipant]

From what I read ONJ is usually triggered by an extraction which doesn’t heal. That is why the doctors advise you to have all dental work done before starting zometa. If mum needs any extractions or root canal work done I think they advise waiting another 3 months before starting the zometa as well. ONJ seems to be a particularly nasty thing to have so you are wise to be cautious.

Carol

[hlpbParticipant]

Thanks Carol,

It’s such a balancing act between the possibility of ONJ and the possibility of fractures, which could be relatively minor or very serious. Ideally we would go with the consultant’s advice, but other professionals are advising extreme caution if she were to take this route. We’ll keep reading, in the meantime, and I’ll back mum’s final decision either way.

thank you for your interest and input

hlpb

[duskParticipant]

I think this is a complex issue when adults have a history of not robust dental health / oral hygeine and then have chemotherapy, as this is when research suggests risk of ONJ is greater. Extraction of one suspicious tooth before zometa does not mean another will not give problems later during treatment.

Also the risk in relation to fractures is not absolute. It is about treating a population of people with MM with bisphosphonates to reduce a risk of fracture in the population as a whole. Some people start off with stronger bones, others have weaker bones or multiple bone lesions which strengthening of bones would benefit. Myeloma specialists also point out that zometa has a potential small anti myeloma effect and increases survival by a little.

As with any preventative treatment the benefits will outweigh the risks for some individuals and not others due to side effects and their pre-existing state of disease/ health. That is why it is important to look at the whole picture as an individual trying to make a decision and then accept the decision.

 

[hlpbParticipant]

Hi Dusk,

this was really helpful, thank you. Mum’s oral hygiene is good, but age is starting to catch up with her dentition. She would need extractions and a plate, but the dentist said that the teeth next to the plate would probably end up compromised, need extracting and so on. She has no lesions, so the hard push for zometa and dismissal of ONJ by the consultant are confusing. Although we are thrilled with the drop in mum’s pp levels, she has had unpleasant side-effects and is in no rush to add to her medication load. Thank you again for your time and input

[duskParticipant]

hlpb- just to add your mother’s age may mean osteoporosis could weaken bones from both natural age changes in addition to the steroids used in treating myeloma. So it is morey complex to think about risks for for individuals. Lesions alone are not the issue. I expect in your mother’s case it is a balancing act which way to go in the decision for her personally.

[hlpbParticipant]

Dusk,

you are so right about the balancing act. It is also becoming clear that what is right for many may(or may not) be right for the few. I’ll let you know which side of the tightrope she decides to choose. Thanks again!

[Author]

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