🦴 Anti-Resorptive Medications and Oral Surgery: What You Need to Know
Wondering if you can have any surgical procedure in your mouth, like a tooth extraction or placing dental implants while on anti-resorptive drugs? In this post, we explain when it’s safe to proceed with oral surgery and when your medication may need to be paused.
What Are Anti-Resorptive Medications?
Anti-resorptive medications, such as bisphosphonates (Fosamax, Aclasta, Bonviva) and denosumab (Prolia), are used to treat osteoporosis and bone metastases. They work by inhibiting osteoclasts, the cells responsible for bone breakdown, helping to increase bone density.
📌 Main indications:
Osteoporosis
Paget’s disease
Bone metastases in cancer (breast, prostate, multiple myeloma)
🦷 Dental Surgery in Patients on Anti-Resorptive Therapy
Management depends on:
Type of drug (oral, intravenous, subcutaneous)
Duration of treatment
Concurrent medications (e.g., corticosteroids, immunosuppressants)
📍 Oral Bisphosphonates (e.g., Fosamax, Actonel)
< 3 years: No change in treatment plan
> 3 years or taking corticosteroids: 3-month drug holiday before surgery
📍 IV Bisphosphonates (e.g., Aclasta)
< 3 years: Safe to proceed
> 3 years: Delay surgery until 10+ months after last dose
📍 Denosumab (Prolia)
< 3 years: No change in plan
> 3 years: Surgery should be scheduled at the end of the 6-month cycle
⚠️ Risk of Osteonecrosis in Cancer Patients
Patients on IV anti-resorptive drugs for cancer have a higher risk of osteonecrosis of the jaw (ONJ). There are currently no standardized protocols for drug discontinuation. A multidisciplinary approach with the oncologist is recommended.
✅ In Summary:
Before any oral surgery, it is essential to:
Take a detailed medical history
Assess the type and duration of anti-resorptive therapy
Collaborate with the patient’s physician if needed
Get more information here: Osteonecrosis
