Altering the Progression of Human Alveolar Bone Loss With the Non‐Steroidal Anti‐Inflammatory Drug Flurbiprofen

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Abstract
The treatment of human periodontal diseases relies on mechanical and antimicrobial suppression of the etiologic bacteria. The ability to alter the progression of periodontitis by additionally blocking host pathways involved in the destructive process is an area of current research. Prostaglandins and other metabolites of arachidonic acid are believed to be important host mediators of the bone resorption of diseases such as periodontitis. We have previously examined the effect of inhibitors of prostaglandin production, non-steroidal antiinflammatory drugs (NSAIDs), on inhibiting alveolar bone loss in beagles. The present study was designed to examine the effect of the NSAID, flurbiprofen, on slowing the radiographic loss of alveolar bone in the human. Fifty-six individuals with radiographic evidence of alveolar bone loss were recruited for study. Forty-four patients remained in the study for the data analysis of loss of alveolar bone. Following a 6 month baseline pretreatment period to measure the radiographic progression of bone loss, half of the patients were administered flurbiprofen, 50 mg. b.i.d., while half were administered a placebo. All patients received a subgingival scaling and pumice by a hygienist every 6 months. The rate of alveolar bone loss in a 2-year treatment period was compared to the baseline 6 month pretreatment period within and between patient groups. Throughout the study, teeth exhibiting obvious loss of bone were exited from study and treated with conventional mechanical therapy. At the end of the pretreatment period both patient groups had a similar mean rate of alveolar bone loss. In individuals given placebo tablets, the rate of bone loss was significantly (P < .05) less than baseline at 6 and 12 months of treatment, but not thereafter. Individuals given flurbiprofen twice daily had a significant (P < .05) decrease in rate of bone loss compared to baseline at 6, 12 and 18 months of treatment. In addition we found that at 12 and 18 months of flurbiprofen use the rate of bone loss in the flurbiprofen treated individuals was significantly less than in the placebo patients. However at 24 months of the treatment period there was no difference in the rate of bone loss between the placebo and flurbiprofen treated patients. These data suggest that the NSAID flurbiprofen, as an inhibitor of cyclooxygenase, can inhibit human alveolar bone loss as measured radiographically. This finding suggests that pharmacologic agents whose main action is the blocking of host responses involved in the disease process may become adjuncts to anti-infective therapy in the management of bone resorption diseases such as periodontitis.