Osteoporosis Treatment: Do Bisphosphonates Such as Fosamax Cause Tooth Loss?

A silent disease that goes unnoticed for many years osteoporosis is a real problem for many people over the age of 55. It is a bone disease characterized by loss of bone density and as a result, the bones become more fragile, and the risk and severity of fractures increase dramatically. Factors involved in the regulation of bone mass are vitamin D and, in particular, sex hormones. The disease is mainly associated with hormonal changes related to menopause in women and, although it can also affect men, it is more frequent in women. In the US, 30% of postmenopausal women may have osteoporosis.

Osteoporosis Guide

Osteoporosis Guide

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For some, the loss of bone mass has no serious consequences, but for others, an abnormal acceleration of bone resorption that is not compensated by adequate bone formation leads to an excessive loss of bone mass and strength. Once osteoporosis has started, the physician will first treat any vitamin D and/or calcium deficiency, primarily by encouraging the patient to change their diet. They will also encourage the patient to be more physically active, to reduce their alcohol and salt intake, and to stop smoking if they are a smoker. However, if the disease is confirmed and worsens, the physician may prescribe different medications. Among them are bisphosphonates. Some people however have linked them to tooth loss.

There is data showing a certain relationship between osteoporosis and the likelihood of tooth loss. In general, therefore, patients with osteoporosis should take the utmost care of their oral hygiene and consult their dentist regularly. But the biggest problem comes from certain treatments: bisphosphonates, which can cause a serious complication: osteonecrosis of the jaw. Although this phenomenon is extremely rare (one person in 10,000 is affected), “there is sometimes confusion among patients who think that osteoporosis treatment can be harmful to teeth, which is clearly not the case. For this reason, it is recommended that patients undergo an oral check-up before starting treatment.

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Some dentists recommend not treating osteoporosis

Osteoporosis is not associated with jaw fracture and we don’t have concrete data on the effects of treatment on the jaw. The alveolar bone, which supports the teeth, is susceptible to aging, hormonal factors, and, above all, local factors such as chewing and, of course, the condition of the teeth. Again, a diet rich in vitamin D is recommended. This is likely to benefit both the patient’s teeth and skeleton.

But if the data show no particular risk, why do dentists continue to be against certain treatments for osteoporosis?

There is confusion among dentists between the bisphosphonates (Fosamax) that are used in people with osteoporosis and the bisphosphonates that can be prescribed to sicker patients, such as those affected by bone cancer. Some similar molecules are used in both cases, but in bone metastases, the doses used are much higher. The real problem with osteonecrosis of the jaw is whether you have bone metastases. The incidence of this phenomenon is then much higher, affecting 1% or even 10% of patients. As for tooth extractions, it is perfectly possible to have them performed even if you have osteoporosis and are being treated with bisphosphonates.

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Final Thoughts

Unfortunately, many dentists consider this treatment too dangerous. Therefore, a dialogue should be established between all the doctors involved and the patient. And if a patient has a very high risk of fracture, it would be wise to start treatment very soon. On the other hand, in less urgent cases where bone density is still reasonably good, it makes sense to carry out the needed dental treatments as they become needed.

That’s why it is important to have an oral exam before starting bisphosphonate treatment. However, if the risk of fracture is very high, consider starting treatment before undergoing any invasive dental procedures.

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Dental complications and management of patients on bisphosphonate therapy: A review article





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