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The Silent Side Effect of Bone Treatments
Millions of people take medications like bisphosphonates and denosumab to treat osteoporosis and other bone diseases. While these drugs are effective in strengthening bones and preventing fractures, new research has spotlighted a serious—though rare—side effect: osteonecrosis of the jaw (ONJ).
ONJ occurs when blood flow to the jawbone is reduced, causing the bone to die. Symptoms include jaw pain, swelling, and exposed bone. Though the risk is low, it’s significant enough to concern doctors and long-term users alike.
Understanding the Medications Involved
Bisphosphonates
Drugs like alendronate (Fosamax), risedronate (Actonel), and zoledronic acid (Reclast) are commonly prescribed to slow bone loss. They do this by inhibiting bone-resorbing cells called osteoclasts. These medications are often the first choice for treating osteoporosis.
Denosumab
Denosumab (Prolia, Xgeva) is a monoclonal antibody given via injection. It targets a protein involved in bone breakdown, making it a preferred option for patients who can’t take bisphosphonates or are undergoing cancer treatments that affect the bones.
Who Is at Risk?
Although osteonecrosis of the jaw is uncommon, certain factors raise the likelihood of its development:
Dental Procedures
Invasive dental work like extractions or implants can trigger ONJ in vulnerable individuals.
Cancer Treatments
Patients receiving chemotherapy or corticosteroids along with bone medications face a heightened risk.
Pre-existing Health Issues
Conditions such as diabetes, anemia, and poor oral hygiene may contribute to ONJ risk.
Research from the University of Oulu in Finland found a higher incidence of ONJ in patients who took both corticosteroids and bone medications.
Preventive Measures and Expert Recommendations
- Dental Exams: Get a full dental check-up before starting bone medication.
- Oral Hygiene: Brush, floss, and visit your dentist regularly to minimize risk.
- Tell Your Dentist: Always inform them if you’re on bone-strengthening drugs.
- Watch for Symptoms: Report jaw pain, swelling, or exposed bone immediately.
Doctors emphasize the importance of balancing the benefits of bone medications with their rare risks, especially when dental surgeries are needed.
Looking Ahead
As science advances, it’s vital that patients and medical professionals remain alert to the hidden risks of widely-used medications. A proactive approach—open conversations between doctors, dentists, and patients—can lead to better outcomes and fewer complications.
Reference: “Incidence of medication-related osteonecrosis of the jaw and associated antiresorptive drugs in adult Finnish population” by Miika Kujanpää, Ville Vuollo, Antti Tiisanoja, Marja-Liisa Laitala, György K. Sándor and Saujanya Karki, 19 May 2025, Scientific Reports.
DOI: 10.1038/s41598-025-02225-2
What’s Next?
Are other common medications hiding similar risks? Keep exploring the intersection of medicine and discovery at DailySciTech.com.
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