A Decade of Research on Osteonecrosis of the Jaws Reveals but One Example of a Massive Public Health Problem
by Dr. Robert E. Marx
During more than three decades as a researcher and professor of oral and maxillofacial surgery, it has been my privilege and honor to oversee the training of many talented residents and fellows who have gone on to serve with distinction in research facilities and practices of their own. Our careers as scientists are rewarding on myriad levels. Helping suffering patients, educating and training future doctors to do likewise, and investigating through studies and research the ways in which we may better serve our communities.
In these capacities, we are sworn to bring forth the truth of our discoveries, whether the results are good or whether they are bad. So I am compelled by oath, duty, and conscience to say that I have some bad news for you today. It was bad news for me, and it will probably be bad news for you. While we have seen growing numbers of class action suits against pharmaceutical corporations for marketing harrowingly harmful drugs in recent years–Actos, Benicar, Effexor, Fosamax, Mirena, Vioxx, Yaz, and so forth–these represent only the tiniest tip of the proverbial iceberg.
In 2003, I published a paper on the growing epidemic of bisphosphonate-induced osteonecrosis of the jaws (BIONJ). Osteonecrosis means death of bone, and I saw more and more patients treated for osteoporosis with intravenous bisphosphonates losing sections of their jaw. My study focused on pamidronate (Aredia) and zoledronate (Zometa), both intravenous medications, but I also became increasingly suspicious of the most common treatment for osteoporosis–oral bisphosphonates. During the intervening 12 years, I have personally documented over 50 cases of BIONJ caused by the oral drugs. Some of these patients lost half of their mandible or more. Another 4,000 cases have been reported to the FDA, and though the pharmaceutical companies that market these drugs well know of the BIONJ connection (Merck settled over a thousand Fosamax-related BIONJ lawsuits in 2013), neither entity has acted toward their recall.
The density of evidence against bisphosphonates is strong and solidly rooted in science. Yet it is the famous and ubiquitous greed of the pharmaceutical companies, along with the FDA’s ignoring and/or not seeking to discover the serious side effects of these osteoporosis drugs, that has allowed the preventable suffering of BIONJ to multiply. Worse yet, the bisphosphonates are but one class among thousands whose debilitating, sometimes fatal, effects are obfuscated by the $71.1 billion industry.
Addressing a grave problem of the era, Dr. Martin Luther King warned in 1967 that “If America’s soul becomes totally poisoned, part of the autopsy must read “Vietnam.” Today we must heed another warning: If America’s blood and bones become totally poisoned, part of the autopsy must read “Pharma.”
Robert E. Marx, DDS is Chief of Research and a professor of surgery at the University of Miami’s Miller School of Medicine’s Division of Oral and Maxillofacial Surgery. He is a graduate of Northwestern University.