Zoledronic Acid Improves Periodontal Outcomes in Patients With Osteoporosis

Retired lady feeling discomfort in mouth, inflammation of gums, periodontitis
Patients with osteoporosis who maintain good oral hygiene can use zoledronic acid to effectively prevent symptomatic periodontal disease and tooth loss.

Patients with osteoporosis who maintain good oral hygiene can use zoledronic acid to effectively prevent symptomatic periodontal disease and tooth loss, according to study results published in Menopause.

In this clinical trial of zoledronic acid’s efficacy in reducing the risk for tooth loss caused by periodontal disease (ClinicalTrials.gov Identifier: NCT01522521), researchers randomly assigned 665 patients with osteoporosis to receive 5 mg zoledronic acid (n=333; average age, 74.0 years) or placebo (n=332; average age, 74.3 years) once per year for 2 years using a 15-minute intravenous infusion. No participants had symptomatic periodontal disease at baseline and all had monthly visits with physicians to evaluate for signs and symptoms of oral disease and other dental adverse events.

Compared with the control group, the treatment group had significantly fewer dental adverse events (67 vs 47 cases, respectively; P =.04), as well as a significantly lower frequency of observed symptomatic periodontal disease (40 vs 18 cases, respectively; P =.002). Marginal periodontitis was observed in 29 patients receiving placebo vs 16 patients receiving zoledronic acid (P =.046). Patients in the placebo group were also at significantly greater risk for apical periodontitis than patients in the treatment group (P =.012).

Although not statistically significant, more patients in the control group experienced loss of teeth than patients in the treatment group (36 vs 24, respectively). In addition, 23 patients receiving treatment and 32 patients receiving placebo underwent tooth extraction during the 2-year study period, most commonly due to periodontitis.

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More patients in the group receiving zoledronic acid discontinued the study (n=75) compared with patients in the placebo group (n=48), but the overall rates of adverse events were similar in both groups.

Study limitations included its relatively homogeneous population of patients who practiced good oral hygiene, which might not accurately represent all patients receiving zoledronic acid.

“[Z]oledronic acid was more effective than placebo in preventing symptomatic periodontal disease in [patients with osteoporosis] who maintained good oral hygiene,” the researchers said. “Because zoledronic acid can prevent symptomatic periodontal disease when combined with good oral hygiene management, it is possible that the procedures performed in this study could eventually suppress the development of [osteonecrosis of the jaw].”

Disclosure: This clinical trial was supported by Asahi-Kasei Pharma Corporation. Please see the original reference for a full list of authors’ disclosures.

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Taguchi A, Shiraki M, Tanaka S, Ohshige H, Nakamura T. Improved periodontal disease and prevention of tooth loss in osteoporosis patients receiving once-yearly zoledronic acid: a randomized clinical trial [published online August 19, 2019]. Menopause. doi:10.1097/GME.0000000000001393