Osteoporosis medication and implant planning intersect in a way that requires specific attention, and the relevant history is one patients frequently do not think to mention.
The medications concerned
Bisphosphonates, taken orally for osteoporosis or administered intravenously in oncological contexts, and denosumab, given by injection. Both reduce bone turnover, which is their therapeutic purpose.
Because reduced turnover also affects healing after bone surgery, these agents are associated with medication-related osteonecrosis of the jaw.
Putting the risk in proportion
For patients taking oral bisphosphonates for osteoporosis, the risk following dental surgery is low. It is not zero, and it rises with duration of therapy, but it does not preclude implant treatment in most patients.
The risk associated with high-dose intravenous administration in oncological treatment is substantially higher, and implant placement is generally avoided in that group.
Why the history is so often missed
Annual or six-monthly injections are the commonest omission. Patients genuinely do not think of an injection they receive once a year as medication, and questionnaires asking what do you take daily miss it entirely.
Discontinued therapy matters too. These drugs persist in bone for years after they are stopped, so a course finished five years ago is still relevant.
Practical approach
Report any treatment for osteoporosis or bone metastases, current or past, including injections and infusions, with approximate dates and duration. Coordination with the prescribing physician forms part of appropriate planning.
Establishing periodontal health before any surgical treatment is particularly important in this group, since infection is a recognised precipitant.
Tell us about it even if it was years ago and even if it was only an annual injection. It rarely changes what is possible, and it always changes how carefully we plan.
If you want to know how this would apply to your smile, book a remote consultation with us.
