[vmeyer]

Can Zometa interfere with the healing of fractures?

by vmeyer on Thu Apr 26, 2018 10:50 am

My husband goes to a dentist who specializes in treating cancer patients and others with medical conditions that change the nature of their dental procedures. He commented to my husband that they don't like to do extractions on someone who has taken Zometa, even if not recent, because the jaw doesn't tend to heal well.

That has led my husband to wonder whether his having taken Zometa had anything to do with his non-healing femoral fracture. I think he was kind of a "perfect storm" for having it not heal: myeloma lesions on the femur, previous radiation for the plasmacytoma he had in the femur, myeloma itself, dexamethasone at the time, age.

But was Zometa part of the problem as well?

Zometa is supposed to strengthen the bones, but might it have the opposite effect on fractures?

[dianaiad]

Re: Can Zometa interfere with the healing of fractures?

by dianaiad on Sat Apr 28, 2018 12:27 pm

Part of the problem with bone strengtheners, like Zometa (zoledronic acid) and Aredia (pamidronate), are that they can cause or exacerbate something called 'osteonecrosis of the jaw.' It's a well known problem, and one of the reasons that, before I began treatment, I chose to have my teeth pulled and went with dentures.

Not that I recommend that, at all! However, I was in need of extensive dental work, and the dentist, once he found out that I was 'going on' Zometa, declined to do much of the work required. So, I got 'store bought' teeth, and I'm quite happy with that decision.

I really don't know whether Zometa interferes with bone healing elsewhere; I wouldn't think so, since the whole point of Zometa and Zometa-like treatments is to strengthen the bones. However, if there have been any studies one way or the other, I don't know about them.

Not that there aren't any. I just haven't looked.

[Multibilly]

Re: Can Zometa interfere with the healing of fractures?

by Multibilly on Sat Apr 28, 2018 7:07 pm

You might want to read through these studies:

Xue, D, et al, "Do bisphosphonates affect bone healing? A meta-analysis of randomized controlled trials," Journal of Orthopaedic Surgery and Research, June 5, 2014 (full text of article)

Colón-Emeric, C, et al, "Association between timing of zoledronic acid infusion and hip fracture healing," Osteoporosis International, Aug 2011 (abstract)

Hayer, PS, et al, "Effect of zoledronic acid on fracture healing in osteoporotic patients with intertrochanteric fractures," International Journal of Applied and Basic Medical Research, Jan-Mar 2017 (abstract; full text at Pubmed Central)

In a nut, the studies generally show that Zometa does not interfere with the healing of fractures.

However, I assume the femoral fracture was pathalogical in nature and due to myeloma and not directly due to trauma or osteoporosis. So, you should keep the nature of the fracture in mind as you go through these studies.

While I'm certainly not a doctor, I suspect that the radiation therapy's negative effect on the femur's blood supply and osteoblasts (the bone cells that build up the bone matrix) probably has a lot to do with the fracture not healing - along with the destruction of the bone matrix by any myeloma-related lytic lesions. But this would obviously be something good to discuss with your doctor.

[vmeyer]

Re: Can Zometa interfere with the healing of fractures?

by vmeyer on Sun Apr 29, 2018 9:56 pm

I will probably ask about that when we go back to his ortho oncologist in late May. She said she couldn't imagine that it would ever have healed due to the large lesions in that area. She removed about five inches of bone entirely and replaced that part with essentially a metal femur. Quite a complex procedure, judging from the x-rays, but he's on two legs, no cane, now.

The question about Zometa was prompted by his dentist's comment. It just made us wonder if the jaw wouldn't heal, why the jaw and not the leg?