Risk To Jaw Bone From Bisphosphonates

Posted on Apr 06, 2015 by William J. Claiborne, DDS MS

As we age, our bone strength and density naturally declines. If you’ve ever seen an adult who is permanently hunched over when they stand or walk, that’s commonly due to severe osteoporosis. Avoiding such health issues has motivated millions of adults to take bisphosphonates to minimize, prevent or counteract further bone loss. An unfortunate side effect of bisphosphonates, however, is bone necrosis.

Bone necrosis is a condition that occurs when there is loss of blood to the bone. Because bone is living tissue that requires blood, an interruption to the blood supply causes the bone to die and eventually collapse. Osteo-necrosis of the jaw develops when the jaw bone fails to heal after a minor injury or disruption to the bone that requires healing — for example, having a tooth pulled or an implant placed.

Although the risk level for those who take oral bisphosphonates (such as Fosamax, Actonel, Boniva) is low, a higher risk exists for those taken as part of cancer therapy.  These are given intravenously (such as Aredia, Bonefos, Didronel, Zometa) to reduce bone pain and abnormally high calcium levels in the blood.

The precise cause-and-effect relationship between bisphosphonate use and jaw osteo-necrosis is still unknown. The Mayo Clinic estimates the risk is 0.1 percent, meaning the condition occurs in 1 out of every 1,000 taking bisphosphonates over the period of a year or more. Although the risk is low, it still exists.

Taking bisphosphonates does not prevent one from having dental implants or other dental procedures. For example, we have our dental implant patients stop taking the medication six months prior to the placement procedure. Once their implant treatment is complete, they can resume bisphosphonate medication.

Other medications can also have adverse effects when your dental professional is not informed of all you are taking. For example, Coumadin, a blood thinner, can cause a greater degree of bleeding during extractions and other procedures. This is why it is important to provide your dentist with a list of all medications you take and the dosage of each. This includes herbal supplements.

Our goal is to create an ideal outcome for every procedure you have in our office. If you have questions, call (828) 274-9440.