Osteoporosis and Dental Work

I think you should have the implant, I'm not sure you should take Prolia. The trouble with Prolia is that it prevents your bones from remodeling. Eventually your bones become avascular. So the bones are brittle because they haven't been renewed and then they become even more brittle. Many oral surgeons won't do surgery for patients on Prolia. Prolia weakens the immune system which makes you more susceptible to the ever-present germs in your mouth. Often we get antibiotics. But on Prolia there isn't the vascular system to take the antibiotic to a bone infection. All the bone can do is decay. There is a risk of osteonecrosis of the jaw with the use of Prolia.
Some never experience this and since you are just beginning Prolia, you might escape unharmed. But there is the risk of osteonecrosis with Evenity. So you might be set-up for harm. You might talk to you endocrinologist about pausing a month and starting Prolia at the end of September. It is safer if you've already had the root canal on that tooth. You probably know that once you start Prolia, it is difficult to stop the medication.

I had an extraction & implant before Prolia. I’ve had 4 Prolia injections and recently needed a root canal. The endodontist said he would send me to an oral surgeon, but an oral surgeon would refuse to treat me because of Prolia. The endodontist prescribed amoxicillin for ten days as a preventative measure. I started it two days before the root canal. He filled the interior of the tooth with calcium and added a temporary seal. I wait four weeks and return to see how it is working. Best case scenario I will need a new crown. If the tooth doesn’t look better, grind the tooth down to just below the gum line, seal off, and over time the body will absorb what is left of the tooth.
Implants are no longer an option due to Prolia. I regret going on it. I’m 79 and my mother had osteoporosis and refused to take Fosomax. She fell and broke several vertebrae. Her bones were so brittle drs couldn’t help her. She died 4 weeks after the fall. Watching her suffer made me want to try something, anything. Prolia is about as good as some other choices but dental issues create serious problems. I’m due for a 5th Prolia injection late September. I would like an alternative. Having a Dexa scan this month to see if two years of Prolia helped.

I had been on Prolia 5 years and needed a tooth extraction and a titanium implant. Long story, but my Rheumatologist gave the Periodontist the OK. Little or no warning from Rheumatologist and none from my Periodontist until a few minutes before he pulled the tooth regarding possible issues; I almost backed out of the procedure. My periodontist took several x-rays of my jaw/tooth over a 7 month period, checking for any issue pre and post extraction. He had me wait 7 months to complete the procedure and then another two weeks before having the crown.
I have since done my own research reading reputable scientific journals. It is recommended that you have the tooth pulled and implant procedure as close to the end of a Prolia injection (5.5-6 months post injection). There are additional issues for those with cancer that have had radiation so it is best to consult with a bone specialist or experienced oral surgeon. Ask all the questions you can, explain your worries share journals with them ask the what ifs….
Unfortunately my rheumatologists and periodontist were more concerned about jaw necrosis than the Prolia “holiday” I was on for 3 months post dental work. I am 71 and have never broken a bone in my body until I fractured my L-1 and L-3 not due to dental work but due to not getting back on Prolia within a shorter period. My rheumatologist never discussed the need to get right back on Prolia, even after she had me get an x-ray due to back pain 10 days before I fractured. I have since shared the research regarding Prolia and dental procedures and given it to my dentist, periodontist and rheumatologist. I am certain from my conversations w each they had little understanding of the side effects from Prolia when getting invasive dental work.
I have an appt. with an Endocronologist that specializes in bone health in February. I am hoping to find a way to relay off of Prolia. (She had a 12 month waitlist). Sadly knowledgable physicians are few and far between and these bone meds are fairly new and research is starting to get published. I hope my story empowers you in some way❤️

That is exactly how I hit the nightmare of osteoporosis.
I was told to go off of it before extraction/implant, which I did. I was due for my next dose of Prolia about 6 weeks after dental procedure. My doctor said it would be fine.
I had the tooth extracted and let that heal then the bone graft, let that heal and then the implant.
That whole process took about 8 weeks.
Once you stop Prolia, your bones deteriorate rapidly. PLEASE READ UP ON THAT.
After four weeks off Prolia, I had my first compression fracture. 5 more followed rapidly within weeks. Another two at one time followed by three more all at once.
The hospital had me checked by an Orthopeadic Spine Specialist who explained all this to me, telling me my bones were so soft, he was able to move them.
I've had two surgeries so far. He immediately sent me to their bone clinic where I am now treated by a doctor who specializes strictly in Osteoporsis. I am now on a treatment of Tymlos for two years. I have seven months to go and my bones show remarkable improvement. I've gone from osteoporosis to low bone mass in all measured areas. I am getting annual dexa scans to monitor progress. I'm not sure what I will be taking at the end of two years, but I will have to go on something.
PLEASE do read everything you can find about stopping treatment!!
I will try to find some information for you and will post it this evening.

Let me also mention the snowballing of other issues this has caused. I now have very thin jaw bones and need two implants but the doctor is not sure there will be enough bone to hold them. My face has sagged and I drool. The pain from the fractures was awful. I could not lay down. I slept in a chair. It was too painful to lift my legs to rest them on the ottoman. That led to blood pooling at my ankles, appointments with a vascular surgeon and ultimately vascular surgery. Now I have bulging veins and must wear ugly compression socks forever. I have a huge hump in my back which makes it impossible to lay flat, wear a bra that hooks in the back, sit in a wooden chair or look nice in blouses or tops, (baggy shirts are my new wardrobe). At the completion of my Tymlos treatment, we will begin to consider placing rods in my back to straighten it. I have lost 3" in height and gained a muffin top. I WAS 5'4" and 110# now I am 5'1". You would be amazed at the difference that is. I cannot reach in cabinets. All slacks and dresses have to be altered. I had a very tight, flat stomach. That 3" had to fall somewhere, so it fell right to my waist along with my boobs!
Ask your doctor if you can go off Prolia and on somethimg else before dental work.
I wish you the best and will be thinking of you. Just do your research, get a second or third opinion.

I do not want to take the Reclast infusion my endocrinologist recommended for my osteoporosis. I’ve never had any type of fracture. I also have rheumatoid arthritis and have read that Reclast can cause major long term problems with someone with RA. I haven’t been to the dentist in probably 8 years due to extreme anxiety so would need to go before even reconsidering Reclast. I read some recent journal articles from well respected sources that stated that even with osteoporosis meds, that it doesn’t improve osteoporosis all that much, around 3%. Seems to me that the risks outweigh the benefits. Anyone have thoughts on this? Would be appreciated. Thank you.

I am in a state of panic as I never was informed about rebound drugs and dental work....After 2 yrs of prolia, I went from osteoporosis to osteopenia. Dr wants me to start Reclast but my dentist says I would have to wait a full yr if I had dental issue. Why do they get you off Prolia if it's working? Are there side effects or risks of taking Prolia for longer than 2 years? And how long does one remain on Reclast?

mwendt54, Is there any reason that you couldn't take either Forteo or Tymlos. They are both used with dental work (hope you don't need any). And they protect the bones vulnerable because of RA. A general observation from these pages is that people with autoimmune diseases have a more difficult time with Reclast side effects.
The percentages you read about don't refer to the anabolic drugs that build new bone.
These are the two that many endocrinologist are saying should be taken before bisphosphonates.
It's kind of hard to reconcile taking medications for conditions that we don't feel any harm from. That's what is so tricky about osteoporosis. They call it the silent disease. You wouldn't know you had it without the scans until you fracture.
Anyone who has a fracture will advise you--Dont risk it.

jan12345678, Prolia is the rebound drug. Reclast is to protect you during the rebound period from Prolia. Does your dentist know you are on Prolia now, because Prolia has a greater risk for bone death with dental work than Reclast. It isn't just rebound that creates the risk from Prolia. It is the way both of these drugs work. They stop the cells that clear away older fissured bone. And that stops the cells that come in afterward to build new bone. So you end up with bones that are brittle and without an adequate blood supply. Prolia's mechanism collects the cells that remove damaged bone in their final stage of development. When you stop the drug, these cells finish developing quickly and engulf your bones in an acidic bath, often resulting in multiple fractures. Reclast prevents these osteoclast cells from attaching to the bone and causes them to self destruct.
Currently Reclast is the only medication that can safely make the transition away from Prolia.
Invasive surgeries--root canals or extractions create the risk. Cleanings and fillings are not a problem.
Prolia adds new bone very quickly to the outside of the existing bone. If a patient were at imminent risk of fracture or if they had cancer metastasized to the bone, Prolia would be a good consideration. But it takes that bone back and even more than it has given rapidly, when you stop the drug.
I suspect anyone knowing this about Prolia would never take it. Your doctor is showing you the proper escape route. It will very likely be successful.

If you just google....... risks of stopping Prolia or What happens to your bones, if you stop Prolia, you will find a lot of helpful information.

Best of health to you.

So much good information in this thread -- thanks @gently and others. @gently, do you have any information on whether Fosamax or Reclast is "safer" -- meaning less likely to cause ONJ??? I haven't been able to find much info, and my doc (a specialist at Cleveland Clinic) is recommending Reclast once I stop Tymlos. According to her, both stay in your bones, so one is not better than the other. I was thinking Fosamax would be better because you could stop taking it if you needed invasive dental work.