If you take a bone-strengthening medicine for osteoporosis, you may have heard of a rare jaw problem linked to these drugs. The American Dental Association (ADA) calls medication-related osteonecrosis of the jaw (MRONJ) a rare but serious side effect, and also concludes the benefits of treatment outweigh this low risk for people with osteoporosis. For broader tips, see oral health for older adults. This guide explains the facts so you can talk to your dentist and doctor. Don’t stop a prescribed medicine on your own.
Which medicines are involved
The ADA lists antiresorptive drugs used for osteoporosis, including bisphosphonates (such as alendronate, ibandronate, risedronate and zoledronic acid) and denosumab, plus romosozumab. Some of these drugs are also given at higher, more frequent doses for cancer that has spread to bone. The ADA says other osteoporosis medicines, such as teriparatide, abaloparatide, raloxifene and calcitonin, are not associated with the same risk.
What MRONJ is
Osteonecrosis of the jaw is an area of exposed jawbone. The ADA says it usually causes pain and pus but may cause no symptoms. It typically follows tooth extractions or other surgery involving the jawbone, but can occur on its own.
Symptoms to report
MedlinePlus’s drug information for alendronate, a common bisphosphonate, lists these mouth and jaw symptoms to tell your doctor about:
- painful or swollen gums
- loosening of the teeth
- numbness or a heavy feeling in the jaw
- poor healing of the jaw
It also warns the drug can cause mouth sores if not taken as directed, so follow the dosing instructions.
How rare is it?
The ADA reports estimates between 0.001% and 0.01% of patients taking oral bisphosphonates for osteoporosis, and between 1% and 10% of patients taking IV bisphosphonates for cancer that has spread to bone. An ADA expert panel put the highest reliable estimate at about 0.10% for osteoporosis doses.
Risk factors
The ADA lists:
- age over 65
- gum disease (periodontitis) and poor oral hygiene
- jawbone surgery, including tooth extraction
- high doses or use for more than 2 years
- smoking and diabetes
- cancer, chemotherapy, corticosteroids or antiangiogenic drugs
- wearing dentures
Before you start the medicine
MedlinePlus advises that a dentist examine your teeth and do any needed treatment before you start alendronate. Tell your doctor about any mouth, teeth or gum problems or mouth infection. While taking it, brush and clean your mouth well, and talk to your doctor before any dental treatment.
- Book a dental exam before your first dose if you can.
- Finish needed fillings, extractions or gum treatment first.
- Keep up checkups during treatment and tell every dentist you see about the medicine.
What the ADA recommends
The ADA’s expert panel says “an oral health program consisting of sound hygiene practices and regular dental care may be the optimal approach for lowering [MRONJ] risk.” In practice:
- Tell your dentist about any osteoporosis or bone medicine, including injections.
- Keep up daily brushing, cleaning between teeth and regular checkups. Treating gum disease early may help avoid extractions.
- Ask your dentist and doctor to coordinate before extractions or implant surgery.
- If you’re having cancer treatment, ask about dental care first. See dental care during cancer treatment.
Frequently asked questions
Should I stop my osteoporosis medicine before dental work?
Not on your own. The ADA says fracture risk from osteoporosis is considerable and treatment benefits outweigh the low MRONJ risk. Discuss timing with your doctor and dentist.
Can I still get dental implants?
Ask your dentist. The ADA lists jawbone surgery as a risk factor, so your dentist will weigh your medicine, dose and history.
Sources
- ADA: Osteoporosis Medications and Medication-Related Osteonecrosis of the Jaw
- MedlinePlus: Alendronate
By the Dentist Review Editorial Team.
This article is for general information only and is not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.
Featured image: “Osteoporosis in Bones” by www.scientificanimations.com, via Wikimedia Commons, licensed CC BY-SA 4.0. Resized and compressed for the web.
Our guides are written and reviewed by the Dentist Review editorial team. We research each topic using public, authoritative sources such as the CDC, the National Institutes of Health (NIH/NIDCR), the American Dental Association (ADA) and CMS, and we update guides when guidance changes. Guides are for general information only and are not dental or medical advice; please read our disclaimer and learn more about us.