 Overview
From birth until about age 30, a person’s bones grow longer and increasingly dense, resulting in a strong skeleton. Bone density is affected by diet, physical activity, heredity, hormones, lifestyle and certain medications. Generally, as people age, their bones gradually lose density and strength.
Osteoporosis (os-tee-oh-puh-roh-sis), or porous bone, is a disease that weakens bones and increases the risk of fractures. Bones become fragile as bone mass decreases and bone tissues deteriorate. This can make people more vulnerable to fractures, especially of the hip, spine and wrist.
Osteoporosis affects about 10 million Americans (8 million are women). Another 34 million Americans are at risk of developing osteoporosis. The disease affects more women than cancer, heart disease or stroke combined. Many people are treated with a group of prescription drugs called oral bisphosphonates (bis-fos-fo-nates). Examples include alendronate (Fosamax, Merck, Whitehouse Station, N.J.), risedronate (Actonel, Procter & Gamble, Cincinnati) and ibandronate (Boniva, Roche, Nutley, N.J.).1
Osteoporosis and bone fractures
The risks of osteoporosis, especially the development of bone fractures, are serious. Fractures of the spinal column and hip, which can be life-threatening, are the most common osteoporosis problems.4 The National Osteoporosis Foundation  reports that one in two women and one in four men over age 50 will have an osteoporosis-related fracture in her/his remaining lifetime. Osteoporosis causes more than 1.5 million fractures each year, including more than 300,000 hip fractures and about 700,000 vertebral fractures, 250,000 wrist fractures and 300,000 fractures at other sites.
One in five patients with a hip fracture ends up in a nursing home. Six months after experiencing a hip fracture, only 15 percent of patients are able to walk across a room without help. A woman’s risk of having a hip fracture is equal to her combined risk of developing breast and ovarian cancers.1
Many studies report that the use of oral bisphosphonates reduces bone loss, increases bone density and reduces the risk of fractures. For example, it is estimated that alendronate may reduce by 40 percent the risk of hip fracture in patients with osteoporosis. Thus it is possible that the drug could prevent more than 100,000 hip fractures and tens of thousands of deaths each year.5
Osteonecrosis of the jaw (ONJ)
Recent news reports have alarmed and confused many patients who receive oral bisphosphonates. That’s because uncommon complications are linked to these drugs. The drugs have been associated with osteonecrosis (os-tee-oh-ne-kro-sis) of the jaws (ONJ), a rare but potentially serious condition that can cause severe destruction of the jawbone(s).2
Most cases of ONJ have been seen in cancer patients who receive treatment with intravenous bisphosphonates. To date, about 94 percent of all ONJ cases have been linked to intravenous bisphosphonate use and 6 percent linked to oral bisphosphonates.3 The true risk posed by oral bisphosphonates remains uncertain, but researchers agree that it appears very small.
Given the risks associated with osteoporosis and the proven benefits of oral bisphosphonate therapy, do not stop taking these medications before discussing the matter fully with your physician.
Tell your dentist
If your physician prescribes an oral bisphosphonate, it’s important to tell your dentist so that your health history form can be updated. Because some dental procedures, such as extractions, may increase your risk of developing ONJ, the American Dental Association published treatment guidelines for patients on bisphosphonates.6 The medical and dental communities continue to study ways to prevent and treat ONJ to ensure the safest possible result for dental patients taking bisphosphonates.
Your physician serves as the best source of information regarding your need for oral bisphosphonates. Given the significant benefits of osteoporosis medication, your physician may recommend that you continue taking it despite the slight risk of ONJ. While neither your physician nor your dentist can eliminate the possibility of a patient developing ONJ, regular dental visits and maintaining excellent oral hygiene are essential in helping to avoid osteonecrosis. For more information visit the National Osteoporosis Foundation’s Web site .
References
1 National Osteoporosis Foundation. Osteoporosis Fast Facts. Available at: http://www.nof.org/osteoporosis/diseasefacts.htm . Accessed Mar 27, 2007.
2 Chang, J. S. (2004). “ODS Postmarketing Safety Review.” Department of Health and Human Services, Public Health Service, Food and Drug Administration Retrieved Oct 6, 2006, from: www.fda.gov/ohrms/dockets/ac/05/briefing/2005-4095B2_03_04-FDA-TAB3.pdf .
3 Woo SB, Hellstein JW, Kalmar JR. Narrative [corrected] review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med. 2006 May 16;144(10):753-61. Erratum in: Ann Intern Med. 2006 Aug 1;145(3):235.
4 Riggs BL, Melton LJ 3rd. The worldwide problem of osteoporosis: insights afforded by epidemiology.Bone. 1995 Nov;17(5 Suppl):505S-511S.
5 Nguyen ND, Eisman JA, Nguyen TV. Anti-hip fracture efficacy of biophosphonates: a Bayesian analysis of clinical trials. J Bone Miner Res. 2006 Feb;21(2):340-9.
6 American Dental Association Council on Scientific Affairs. Dental management of patients receiving oral bisphosphonate therapy: expert panel recommendations. J Am Dent Assoc. 2006 Aug;137(8):1144-50.
Special thanks to John W. Hellstein, DDS, MS, Department of Oral Pathology, Radiology/Medicine, University of Iowa, Iowa City, and John R. Kalmar, DMD, PhD, Department of Oral and Maxillofacial Surgery, Pathology and Anesthesiology, Ohio State University, Columbus.
(Reviewed April 2007)
Please note: The ADA does not provide specific answers
to individual questions about fees, dental problems, conditions, diagnoses,
treatments or proposed treatments, or requests for research. Information about
dental referrals, complaints and a variety of dental procedures may
be found here. You can also refer to our Frequently
Asked Questions page for answers to common questions.
| 
