How should agents used to treat or prevent osteoporosis be used around dental procedures?
Osteonecrosis of the jaw (ONJ) has been associated with dental procedures in individuals who are being treated with medications to treat/prevent osteoporosis. Bone Strengthening Agents). Most cases are in individuals using bisphosphonates; however, a number of cases have been reported in individuals using denosumab. There are only rare cases reported in individuals using agents such as estrogens, teriparatide, raloxifene, romosozumab and calcitonin.
To reduce the risk of ONJ, preventative measures including regular cleanings, control of caries and infections, and minimizing bone injury during invasive dental procedures are all recommended. Temporary discontinuation of bisphosphonates prior to invasive dental procedures is commonly seen in practice, but there is no data to support this strategy nor in delaying dental treatment in those already on antiresorptive therapy.