Microsoft word - osteoporosis english article2
OSTEOPOROSIS - BISPHOSPHONATES AND OSTEONECROSIS
DR. GEDALIAH MORDECHAI STERN
Over the past years many people, particularly women, have benefitted greatly from medical
developments in the area of osteoporosis. Medications in the bisphosphonate family such as Fosalan,
Fosamax and the like1 have been very effective in maintaining bone strength, thus preventing
negative developments, once more prominent. Such medications have, as well, saved the lives of
many, with other serious ailments. If you are taking such medication, it is very important that you
better understand them and not proceed with dental care, especially surgical treatment, without a full
understanding and consultation with your doctor.
While these medications help limit the breakdown of bone cells, they also limit the rebuilding of
bone. Bone is always remodeling and must remodel in response to surgical procedures, whether
related to infections, gum treatment, implants or the like. As the bone of the jaw remodels 5 - 10
times more than the rest of the body, the following phenomena are that much more significant in the
jaws than in the rest of the body. Lack of ideal remodeling can result in spontaneous exposure of
bone, which in itself is usually not painful but can get secondarily infected… as a result, and or as a
result of dental treatment, gum care or the like. This can lead to poor healing, infection, non-
integration of implants, breakdown of jaw bone etc.
These developments are much more frequent and serious in patients receiving these medications
intravenously. Fortunately, the frequency among patients taking it orally, is far less and less serious.
The latest literature reports .0007%, or 7 cases in 100,000, and all amongst patients taking the
medication more than 3 years. (By infusion (IV) the frequency is 5-15%). Usually one who needs to
start such IV treatment should first take care of his/her dental needs, if the IV treatment can be
delayed somewhat. Cortisones, when taken with bisphosphonates, can definitely increase the odds of
1 Other common varieties – Actonel, Alendronate, Maxibone, Didronel, Skelid, Boniva, Aredia, Zometa among others.
Bisphosphonates stay in bone over 10 years, even after stopping, and the effect is cumulative with
time. Periodic dental check-ups and x-rays are a must, even more so than usual.
If you are receiving these medications by IV you must consult your doctor before proceeding with
dental care and receive clear instructions as to what you may or may not do. If you are taking these
medications orally, less than 3 years, there's in principle no reason for concern. You should,
however, be aware of the above, take it into consideration and discuss, with your doctor, the
alternatives, including the possibility of taking a "holiday" - stopping for a period or switching to a
non-bisphosphonate. There are cases where one can stop for a year or at least 3 months before and
after dental treatment, implants, etc. If you are taking them more than 3 years you should contact
your doctor and consider these options and others with him/her. In any case, bone levels and activity
can be monitored (CTX, etc…) to see if there is need for concern.
Any treatment requires weighing the benefits and risks, and proceeding responsibly. These
medications have given new life to millions of people around the world. Modern dental treatment, as
well, has opened new horizons previously unimaginable. In order to receive the most out of these
developments, it is important to proceed with responsibility to maximize the benefits and minimize
Fortunately, for most people there is no real danger. Awareness is important – staying abreast of
rapidly changing developments in this area.
In beginning or continuing treatment, we will assume that you have clarified any issues with your
doctor and that you are proceeding with his/her advice and instructions. We ask that any instructions
to us, if any, be done in writing. We hope this has been of help to you. We are happy to be of help in
P.S. Having placed and restored over 30,000 teeth on implants I am happy to report that over the past
close to 30 years, I have, as of this writing, never actually encountered this problem. I would like to
think this is encouraging when considering the odds, the risks and benefits.
DENTAL IMPLANT UPDATE
– While bisphosphonates can, even if rarely, cause the above,
paradoxically some researchers are reporting that in fact, as far as dental implants themselves, they
appear to result in better and faster integration of dental implants,
short and long term! This is
similar to its benefits, strengthening bones, the hip etc…
(AGING, OSTEOPEROSIS AND DENTAL IMPLANTS – Zarb, Lekholm, Albrektsson and
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