Hi @lakecher46, The risk of fractures from osteoporosis outweighs the risk for dental related osteonecrosis with extractions due to the medications for bone loss. Osteonecrosis is very rare and is generally limited to patients who are undergoing heavy chemotherapy.

If there is concern for infection, often the dentist or oral surgeon will suggest a prescription oral rinse to be used before the procedure and they may also put you on a prophylactic prescription for antibiotics the day before, day of and day following the procedure, or for a full 7 day treatment to be safe.

If it’s an extraction, the main goal to protect that area is to keep the blood clot intact in the socket where the tooth was extracted. Just to make you a little more confident going into this dental procedure, again, osteonecrosis is very rare and it is generally limited to just the area where bone was exposed during healing. It’s not fatal and can be repaired surgically. So don’t put off having your dental work done for the very remote chance of having this happen.

Immediately after the extraction it’s important to keep biting on the gauze for 20 minutes or longer to ensure it clots well. No smoking or drinking from a straw for 48 hours. No rinsing vigorously with water/saltwater/mouthrinse for 72 hours. Brushing should be limited to surrounding teeth and no using a toothpick.

There is also a risk of your currently broken tooth under the gum becoming infected. So delaying treatment, though it’s not bothering you now, could lead to other issues down the road. Don’t delay having this done for concern over the risk of infection.
~~~
For the replacement of the tooth there are a few potential options. One being a removable appliance, a partial denture. That would be overkill for just one tooth but there would be no risk of bone related issues with this.

Another is an implant which you mentioned. This will be a greater risk because it involves implanting a metal post into the bone. That’s very invasive. Once the post is set, it needs to heal in place with the new bone growing around it for a set amount of time before a replacement tooth can be anchored to this.

The third option is an actual bridge, either a 2 unit cantilever bridge where a tooth on one side is prepared for a crown. The new replacement tooth is then anchored to that new crown so you’d be getting 2 crowns next to each other but they are attached.
There is also a full bridge where teeth on both sides of the opening are prepared for crowns. The lab then makes 3 adjoined crowns. This is the most stable long term. These last two options are less invasive with only the teeth being trimmed down to support the crowns. No bone is involved, though there will be a little trimming under the gum tissue.
Posting some photos below for you.
1. Picture of implanted post for replacement tooth.
2. Cantilever bridge.
3. Full 3 unit bridge

Tooth extractions and dental work while one bone replacement therapy are a hot topics here in the forum. There are several conversations with members who have the same concerns.

This comment by @willow10 I found to be very relevant to your situation. https://connect.mayoclinic.org/comment/734137/

It’s an excerpt from this discussion regarding:
About to start Prolia, what’s your experience. About to start Prolia: What's your experience?
https://connect.mayoclinic.org/discussion/prolia-1/

Another good discussion for you with @dianestanley @bruceandruth1970 and others:
Anyone had oral surgery while on Evenity?
https://connect.mayoclinic.org/discussion/evenity-and-oral-surgery/

Lots of heavy reading tonight but I hope it helps you make a decision to go forward. What other questions do you have?