Fosamax and tooth extraction

Thank you for this information, and for sending the link to the study. Very helpful. But yes, the question remains: of those who have had to have dental work while on a bisphosphonate, how many have developed ONJ? From the numbers you posted, tho, I guess the number would still be small -- instead of 4 out of 8,572, maybe something like 4 out of 5,000, perhaps??

@sebutler I've been looking for this information myself and he's a recent study I found:Prevalence of Osteonecrosis of the Jaw Following Tooth Extraction in Patients with Osteoporosis: A Systematic Review and Meta-Analysis
Evangelos Kostares 1,*, Georgia Kostare 1, Michael Kostares 2, Fani Pitsigavdaki 3, Christos Perisanidis 3, Maria Kantzanou 1
Editors: Eiji Tanaka, Susumu Abe, Lei Liu
Author information
Article notes
Copyright and License information
PMCID: PMC12429099 PMID: 40943748
Abstract
Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious adverse effect associated with antiresorptive therapy, particularly following tooth extraction in osteoporotic patients. This study aimed to estimate the prevalence of MRONJ after tooth extraction in individuals with osteoporosis through a systematic review and meta-analysis. Methods: A comprehensive search was conducted across three major databases (Medline, Scopus, Web of Science) up to January 2025, including observational studies reporting MRONJ following extractions in osteoporotic patients treated with antiresorptives. Pooled prevalence rates were calculated using a random-effects model, and study quality was assessed. Influence analyses as well as meta-regression were also performed. Results: Twenty-four studies were included, comprising 3784 patients and 5426 extractions. The pooled prevalence of MRONJ was 1.7% (95% confidence intervals (CI): 0.8–3.0%), with considerable heterogeneity (I2 = 77%). When considering only cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) following tooth extraction in patients with osteoporosis, the estimated prevalence was 0.7% (95% CI: 0.1–1.8%), with substantial heterogeneity (I2 = 61%). No individual study was identified as overly influential. Meta-regression revealed no significant associations between MRONJ prevalence and variables such as publication year, gender proportion, or extraction-to-patient ratio. Conclusions: This meta-analysis underscores the importance of vigilance in managing osteoporotic patients undergoing extractions, emphasizing the need for consistent diagnostic criteria and preventive protocols to mitigate MRONJ risk.

Keywords: medication-related osteonecrosis of the jaw, MRONJ, osteoporosis, tooth extraction, prevalence, meta-analysis

@sebutler I've been looking for this information myself and he's a recent study I found:Prevalence of Osteonecrosis of the Jaw Following Tooth Extraction in Patients with Osteoporosis: A Systematic Review and Meta-Analysis
Evangelos Kostares 1,*, Georgia Kostare 1, Michael Kostares 2, Fani Pitsigavdaki 3, Christos Perisanidis 3, Maria Kantzanou 1
Editors: Eiji Tanaka, Susumu Abe, Lei Liu
Author information
Article notes
Copyright and License information
PMCID: PMC12429099 PMID: 40943748
Abstract
Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious adverse effect associated with antiresorptive therapy, particularly following tooth extraction in osteoporotic patients. This study aimed to estimate the prevalence of MRONJ after tooth extraction in individuals with osteoporosis through a systematic review and meta-analysis. Methods: A comprehensive search was conducted across three major databases (Medline, Scopus, Web of Science) up to January 2025, including observational studies reporting MRONJ following extractions in osteoporotic patients treated with antiresorptives. Pooled prevalence rates were calculated using a random-effects model, and study quality was assessed. Influence analyses as well as meta-regression were also performed. Results: Twenty-four studies were included, comprising 3784 patients and 5426 extractions. The pooled prevalence of MRONJ was 1.7% (95% confidence intervals (CI): 0.8–3.0%), with considerable heterogeneity (I2 = 77%). When considering only cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) following tooth extraction in patients with osteoporosis, the estimated prevalence was 0.7% (95% CI: 0.1–1.8%), with substantial heterogeneity (I2 = 61%). No individual study was identified as overly influential. Meta-regression revealed no significant associations between MRONJ prevalence and variables such as publication year, gender proportion, or extraction-to-patient ratio. Conclusions: This meta-analysis underscores the importance of vigilance in managing osteoporotic patients undergoing extractions, emphasizing the need for consistent diagnostic criteria and preventive protocols to mitigate MRONJ risk.

Keywords: medication-related osteonecrosis of the jaw, MRONJ, osteoporosis, tooth extraction, prevalence, meta-analysis

@soggybones here is the link you tried to share to the study:

"Prevalence of Osteonecrosis of the Jaw Following Tooth Extraction in Patients with Osteoporosis: A Systematic Review and Meta-Analysis"
- https://pmc.ncbi.nlm.nih.gov/articles/PMC12429099/

I had my last shot of Prolia in July 2024 and am due for another in January. But on Jan. 2 I had 3 teeth extracted, lower jaw....it was a surprise, doc said he was going to 'save' the teeth and decided during the visit to extract 3!! It was brutal and I'm still experiencing numbness on my chin.

Should I start with Tymlos or something else now? I'm afraid to go back on Prolia, but in '23 there was almost a year off Prolia for other dental work and in the interim fractured 2 vertebrae from lifting heavy trash.

I'm scared to death. Almost 82 yrs. old with osteoporosis for 10 years now. Any help would be so appreciated. TIA

@pianogirl1943 How did you make out with your extractions? I hope your doctor put you on Tymlos or Forteo since there are studies that show these can help with healing after a dental procedure. I know stopping Prolia can be dangerous if you don't follow up with another drug.

@soggybones Thank you for asking. I had the extractions and went back onto Prolia. It's all a matter of timing. Extractions can be done 3 months after the Prolia shot which is 3 months before the next one. I'm about to get a dental implant in January which is 3 months since my last Prolia shot in October.