By: Dr. Evgeny Weinberg DMD, MSc, PhD, Specialist in Periodontology
Osteoporosis is a common malady in which the loss of bone density increases the individual’s risk of incurring bone fractures.
Half of all females and a quarter of all males will suffer a fracture due to osteoporosis at some point in their adult lives.
The classic osteoporosis fractures are fractures of the forearm, the neck of the femur and the vertebral column.
Although some factures occur as a result of a fall, others can occur without any apparent trauma.
The risk of incurring fractures can be cut by about half by means of a variety of medications for osteoporosis!
In the last decade there has been a growing awareness of an oral complication related to taking certain medications for osteoporosis – osteonecrosis of the jaws.
It should be understood that rather than stemming from the osteoporosis malady itself, this complication is due to some of the therapeutic drugs used to treat the condition, for instance drugs belonging to the biophosphonates group.
The incidence of the complication is rare: approximately 0.1% (1 in 1,000) at most.
Osteonecrosis of the jaws manifests itself by areas of exposed bone, with or without localized infection.
It usually occurs in patients who have been taking medications for osteoporosis for many years and who have undergone invasive dental treatments such as tooth extraction, implant surgery and other types of oral surgery.
Treatment is generally conservative in nature, and includes antibiotics and antiseptic mouthwashes.
How can we lower the risk of incurring the complication?
Meticulous oral hygiene and regular follow-up at the dentist and dental hygienist.
Prior to starting drug therapy for osteoporosis, it is recommended to have your dentist perform a dental examination.
Do not stop taking the drug therapy for osteoporosis without first seeking the advice of your treating physician!
Discuss with your physician the possibility of stopping the drug therapy for osteoporosis for three months, both before and after oral surgery procedures.
Check with your physician the possibility of terminating the drug therapy for osteoporosis if you have been taking it continuously more than three years.
In cases where the physician has concerns about an increased risk of developing osteonecrosis of the jaws as a result of prolonged use of drugs for osteoporosis, the patient may be referred for a CTX blood test, which requires the patient to fast beforehand. The objective of the test is to monitor the level of metabolic by-products of Type 1 Collagen in the plasma. Low blood CTX values usually indicate an increased risk of developing osteonecrosis of the jaws in patients who are anticipating invasive oral treatments.
If low CTX values are obtained, the physician will likely recommend postponing the treatment for several months and then having a new CTX test done.