Posted on 5/15/2023 by Greg Kammeyer
|Osteoporosis refers to weak bones that are prone to fracture. Osteopenia describes a less severe condition of weaker bones. Both are diseases without symptoms as the bone loss often occurs without you knowing it. Bones become weak, and are more likely to break (fracture). Certain medications can cause bone loss if used for a longer time (ie Proton Pump Inhibitors used for GERD which cause 3 % bone loss/year). Use over a short time, such as a few weeks or sporadically, is usually not a problem.
Broken bones can lead to pain and disability. For example, some older people who break a hip may lose their ability to function independently. My aunt died of a fractured hip when she fell. A significant percentage of these individuals also tend to have a shorter lifespan after sustaining a hip fracture.
Until about age 30, our body forms enough new bone to replace the bone that is naturally broken down by the body (a process called bone turnover). Our highest bone mass (size and thickness) is reached between the ages of 20 and 25, and it declines after that. After menopause, women begin to lose bone at an even faster rate.
Traditionally an MD will start a patient on Fosamax (a bisphosphonate drug), which hardens the bones yet decreases blood flow to treat osteoporosis. The decrease in blood flow causes problem. At 3 years of use of Fosamax ( in a class of drugs called bisphosphonates), the risk of having a nasty dental healing problem called Medication Related Osteonecrosis of the Jaw (MRONJ) occurs very infrequent (less than 1 % risk) yet potentially a severe problem. At 5 years of Fosamax use that risk increases more and a paper in the New England Journal of Medicine noted that the benefits stop accruing at that point. However if a patient is on them longer than 5 years the risk of the osteonecrosis continues to increase and it takes 11 years for ½ of the drug to wash out. Certainly there are a number of medical conditions that can add to the risk of MRONJ so each patient’s situation is different.
Often when Fosamax no longer is effective and the physician is still concerned about osteoporosis he/she will use one of 2 drugs that are often injected that are not bisphosphonates which are Forteo and Prolea. Forteo is a Teriparatide much like parathyroid hormone. To date I have not seen healing problems from patients on this drug. Prolea (Denosumab) is a twice a year injection, as it washes out of a person’s system over that 6 months. I have had 1 patient problem that was on Prolea for a year and off of it one year. When I did a simple implant surgery for him he had a severe healing reaction that caused the implant to fail and wiped out most of the bone on an adjacent too.
I am no expert in treatment of osteoporosis nor osteopenia. I certainly respect physicians, that osteoporosis is a big problem and yet notice that physicians are becoming much more aware of the potential healing problems for gum and bone surgery. We regularly have patients that their MD says wait to start osteoporosis drugs until after dental treatment is up to date. I am using growth factors regularly, especially for patients like these to encourage bone/gum healing. I write this to encourage you to learn more about the risks and benefits of whatever your physician prescribes you or your patients with these conditions.