Osteoporosis - Oral Health Care Considerations

• No contraindications for dental care, including dental implants.
• Osteoporosis may be associated with a higher incidence of tooth loss.
• Some studies have reported a correlation between osteoporotic bone loss and decreased cortical alveolar bone quality.
• Antiresorptive agent-induced osteonecrosis of the jaw (ARONJ), also known as bisphosphonate- or medication-related osteonecrosis of the jaws (BRONJ) , although extremely rare in patients with osteoporosis who take oral bisphosphonates, has been reported (see Bone HG, et al below).
• Classifications and treatment strategies for provision of dental care have been proposed for patients with ARONJ.
• If the patient is taking glucocorticosteroids for a chronic condition, be aware of possible adrenal suppression and bone pathology.
• A possible association between osteoporosis and the development of arteriosclerosis has been reported.
• Encourage patients to take vitamin D and calcium supplements, stop smoking, limit the use of alcohol, and start weight-bearing exercises.

What medications are you taking?

One of the more controversial medications for osteoporosis is oral bisphosphonate. This medication has been associated with antiresorptive agent-induced osteonecrosis of the jaw (ARONJ), also known as bisphosphonate-related osteonecrosis of the jaws (BRONJ) . Although the risk is extremely low – possibly around 5 cases per 10,000 person/year (see Bone HG, et al. below) – risk factors may include palatal tori, long-term use of the medication, glucocorticosteroid therapy, periodontal and dental diseases, older age, female gender, and traumatic dental procedures.

Classifications and treatment strategies have been developed to assess and provide dental care for patients with ARONJ.

Other nonbisphosphonate-type medications used to treat osteoporosis, including denosumab (Prolia), an injectable human monoclonal antibody, have also been associated with osteonecrosis of the jaws.

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Medical Complexity Status - Osteoporosis

Osteoporosis	MCS1C
Anticipated complication	Controlled/ stable
Hemostasis	None
Microbial  susceptibility	None
Drugs/ drug  interactions	Major
Stress/trauma	Major

See Medical Complexity Status for more information.

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Related Pages

• Medical Disorders
  • Osteoporosis
• Images
  • Medication-Related Osteonecrosis of the Jaws
• Guidelines
  • Medication-Related Osteonecrosis of the Jaw

References/Websites

• References
  • Bone HG, et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol. 2017;5(7):513-523.
  • Cusman F, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int (2014) 25:2359–2381.
  • Gourlay ML, et al. Bone-density testing interval and transition to osteoporosis in older women. NEJM. 2012;366(3):225-233.
• Websites
  • Bone mineral density test. MedlinePlus. U.S. National Library of Medicine. June 9, 2021.
  • Osteoporosis. MedlinePlus. U.S. National Library of Medicice. May 27, 2021.
  • Osteoporosis. Office on Womwn's Health. U.S. Department of Health & Human Services. May 20, 2019.
  • Osteoporosis Overview. National Institute of Artheritis and Muscukloskeletal and Skin Diseases. NIH Osteoporosis and Related Bone Diseases. National Resource Center.
  • Bone Density Scan. MedlinePlus. U.S. National Library of Medicine. August 13, 2020.