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Osteoporosis & Bone Health | Last Active: 3 days ago | Replies (16)
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My rheumatologist insists that the chance of osteonecrosis of the jaw is minimal (I think she said .06 percent) when you are on one of the bisphosphonates, including Fosamax. But I suspect the low risk is assessed using the whole population of individuals taking the drug. I think the relevant statistic would be how many patients on a bisphosphonate WHO UNDERGO A TOOTH EXTRACTION end up with osteonecrosis of the jaw. Does anyone have this statistic? I've been looking on the web but haven't been able to find any studies.
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Here's a study that looked at this: https://pmc.ncbi.nlm.nih.gov/articles/PMC10159647/#:~:text=Prevalence%20of%20ONJ%20among%20Oral,years%20of%20oral%20bisphosphonate%20treatment.
To summarize the results:
9 patients out of 8,572 on bisphosphonates developed ONJ.
5 developed ONJ spontaneously without any dental procedure or dental symptoms.
4 developed ONJ after tooth extraction.
BP durations ranged from 2.6 to 6 years.
4 were healed or almost healed when they completed the survey; 5 were not and in one case was worsening.
There were also 10 more cases where it says they did not meet the specific criteria of ONJ (refers to them as "ONJ-like").
The study discussion at the end is very interesting. Generally speaking, they think the incidence could be higher than what it is and refer to studies conducted abroad that have reached conclusions where the incidence is lower and higher.
I would agree that it makes sense that the incidence is low because many don't need dental procedures but if you do, your risk jumps.