Risk of bone death for Fosamax users

Q. I take Fosamax for osteoporosis. I need to have a tooth extracted, but I heard that my jaw could die if I do this. Is that true?

A. (from a specialist in oral surgery) The risk of bone death (osteonecrosis) from tooth extraction in patients taking Fosamax is very low. Osteonecrosis is characterized by jaw pain, swelling, loose teeth and exposed jawbone.

In fact, if you are at risk for this condition, keeping compromised or infected teeth in place may actually be enough to cause osteonecrosis to develop even without removing the tooth.

Here's some background about the medication to help you and your dentist make a decision:

Fosamax (alendronate) is the most commonly prescribed bisphosphonate, a group of drugs which are used to maintain bone health and treat osteoporosis.

Bisphosphonates affect the ability of bone to heal from trauma, such as dental extractions. And they all remain in the bone for years. Because the intravenous forms are more potent, their effects on bone are thought to be more significant than the oral forms.

A small number of patients who were on Fosamax have developed osteonecrosis of the jaw. These have been primarily associated with dental disease or a recent dental procedure such as extraction.

But this complication has been much more frequent in patients taking the more potent intravenous medications. In one recent study of patients with osteonecrosis, less than 3 percent of the patients had been taking Fosamax, and 97 percent were on the more potent intravenous forms.

Given that there are more patients taking Fosamax than are taking the intravenous forms, it seems that the risk of osteonecrosis from tooth extractions in the patient taking Fosamax must be very low.

The lowest-risk approach would be to try to keep the tooth by having a root canal or other procedure. On the other hand, if there is infection present or if the prognosis for the tooth is not good, removal is appropriate. Talk to your dentist or an oral surgeon about the risks versus the benefits of tooth removal given your particular circumstances.