Fosamax and tooth extraction

Thank you for your reply. It is very helpful. When my dentist first informed me that the tooth would need extraction we discussed taking me off of Fosamax for a time. I had been on a very low dose of Fosamax (35 mg.) due to stomach upset, and after during some research I have now been off of the medication for 6 months, just to be sure. Some information on the internet said don't do the extraction and just manage, while others were recommending ceasing the medication, etc. like you did, and what my dentist instructed. I wanted to get as much feedback from people in my similar situation that did have the procedure done and what their experience has been. Can you tell me more about Tymlos? TIA

tymlos is a daily injection in your abdomen. The needle is small and thin. You turn a small button at the end to get the dose you want to inject. I started at 80 mcg which is 8 clicks but it made my heart pound. Advise on this site said to start low and work up, so I started at 20, then 3o and made it up to 70 after 5 months. I just finally got to 80 mcg at month 7. There is info on the internet about Tymlos which builds bone. It is ok to have dental work while on this med.

I had a similar experience. Was on Alendronate and needed extraction and implant. After discussing with my dentist, I stopped Alendronate for almost a year and proceeded with extraction and implant. Now over a year later, my new implant is solidly in place. I haven’t had a recent bone scan so don’t know if my osteoporosis got worse during the time off Alendronate. I just started it again. Will get DEXA SCAN in May 2025.

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.

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.

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??