Osteoporosis Medications And Dental Concerns

Did you know that 40% of women over age 50 will experience an osteoporosis related fracture in their lifetimes? Broken bones not only decrease your quality of life, they may also shorten your life. Approximately 20% of hip fracture patients die within a year after their fracture.

Your bones lose density and strength as you age. Osteoporosis further weakens your bones and makes fractures more likely. If you’ve been diagnosed with low bone density or osteoporosis, your medical doctor may prescribe medication. These medications belong to a group called bisphosphonates (pronounced biss-foss-phone-ates) which are also used to treat metastatic cancers and other bone diseases. Examples of bisphosphonates are:

• Alendronate (Fosamax)
• Ibandronate (Boniva)
• Risendronate (Actonel)
• Zoledronic acid (Reclast & Zometa)
• Pamidronate (Aredia)
• Clodronate (Bonefos)

Perhaps the most publicized dental complication related to bisphosphonates is osteonecrosis of the jaw. This usually results in an area of exposed bone that will not heal after tooth removal or other oral surgical procedures. It is important to note that osteonecrosis is rare and does not happen to everyone who takes bisphosphonates and has oral surgery. However, when it does occur it can cause serious damage to your jawbone. While there is no way to predict who will have this complication, there are several factors that seem to contribute:

• Treatment with IV bisphosphonates
• Long-term use of bisphosphonates
• Surgical dental procedures
• Trauma in your mouth, especially from dentures
• Dental infections
• Poor oral health

The majority of jaw osteonecrosis cases occur in cancer patients, who have had higher and more frequent doses, often by IV. But oral surgeons are starting to see cases in those who have only taken pill form bisphosphonates for a short length of time.

Currently, there is not a known way to prevent osteonecrosis from developing, but there are some things you can do to try to decrease your chances of needing oral surgery.

Ideally, you should see your dentist before you begin taking medications for your bones. Let your dentist know that you plan to start taking bisphosphonates. If you have any teeth that need to be removed or any oral surgery that is needed, have it done before beginning the bisphosphonates, because the effects of these medicines can stay in the bones for years after you stop taking the medication. Also resolve any dental infections prior to starting your medication.

One you begin bisphosphonate therapy, your oral hygiene is very important. Brush at least twice a day and floss once a day to keep your teeth and gums healthy so that you have less risk for needing a tooth removed. Also have any dental problems fixed promptly to keep them from progressing to the point of needing oral surgery. Choose treatment options that allow you to keep the tooth rather than removing it whenever possible. For example, choose a root canal over removing your tooth.

Continue to see your dentist regularly even if you have dentures. Dentures that do not fit can cause sores or abrasions in your mouth. And remember, all medications have side effects, and bisphosphonates are no exception. Acid reflux, nausea or vomiting all create an acidic environment in your mouth. The acidity can break down your tooth enamel and cause a cavity. Brush your teeth, chew sugar-free gum or rinse with water to reduce acid levels.

Dry mouth means there is less saliva to wash away food particles and oral bacteria. The longer these are in contact with your tooth, the more likely your tooth will decay. Brush your teeth more frequently, use sugar-free candies or gum to stimulate saliva production or sip water frequently to counteract the effects of dry mouth.

If you do develop a mouth problem that requires oral surgery while on bisphosphonate therapy, your dentist may want to consult with your medical doctor about temporarily stopping your medication. You should not stop your regimen without consulting your doctor.

Dental care is important before and during your bisphosphonate treatment. If you are planning to start bisphosphonate therapy and do not have a dentist, please call my office at 440-960-1940.  

NOTE: The information in this article is not meant to replace the clinical judgement of your healthcare professionals.