❓What Is Osteonecrosis of the Jaw (MRONJ)?

In people taking osteoporosis medication (bisphosphonates, or denosumab / Prolia), a small part of the jawbone can very rarely become slow to heal. The medical name is medication-related osteonecrosis of the jaw (MRONJ).
At the doses used to treat osteoporosis, however, this is very rare. It happens far less often than with the high doses used for cancer that has spread to bone.
In fact, stopping your medication on your own out of worry is the bigger risk. Fractures of the spine or hip can happen while the drug is stopped.
The goal is not to quit out of fear, but to keep treatment going while your dentist and your orthopedic doctor share information.

⚙️Why Does It Happen?

The medication slows down bone breakdown

This is what protects you from fractures, but in the jaw it can also make wounds heal more slowly

The jawbone is easily exposed to mouth bacteria

Untreated gum disease or cavities let infection spread close to the bone

A tooth extraction or gum surgery creates a wound

Where infection was already present, the wound may struggle to close

Healing is delayed and bone becomes exposed

Pain, swelling, or pus continues, and bare bone may show through the gum

If it lasts 8 weeks or more, it is diagnosed as MRONJ

The earlier it is found, the lighter the dental or oral surgery treatment tends to be

🦷 Untreated gum disease 🪥 Poor oral hygiene 🚬 Smoking 🍬 Diabetes 💊 Steroid medication ⏳ Long-term use 🔧 Implants and oral surgery

🔍Watch for These Symptoms

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Ongoing pain or swelling in the gums or jaw

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Pus from the gums or a bad smell in the mouth

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A hard, bone-like area visible inside the mouth

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Numbness or tingling in the lower lip or around the mouth

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A tooth that keeps feeling loose for no clear reason

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A tooth socket that will not heal after an extraction (do not wait the full 8 weeks -- tell us as soon as healing seems slow)

💊Prevention & What to Do

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See a Dentist Before You Start

This is the single most useful step. Have your mouth checked and finish any needed dental work before osteoporosis treatment begins

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Daily Brushing & Cleanings

The trigger is mouth bacteria more than the extraction itself. Keep brushing daily and have regular professional cleanings

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Show Your Medication Record

Tell your dentist the drug name, how long you have taken it, and whether it is a tablet or an injection. That alone makes planning much easier

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If You Need an Extraction

Do not stop the drug on your own. Your dentist and orthopedic doctor share information and decide how to proceed together

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A Routine Drug Holiday Is Not Advised

At osteoporosis doses, current guidance does not recommend pausing the drug before an extraction -- pausing has not been shown to prevent MRONJ

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Keep Your Injection Schedule

With denosumab (Prolia), a long delay before the next injection can raise fracture risk. Tell us early if your schedule may slip

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Blood Tests for Calcium

With denosumab, calcium and vitamin D supplements plus regular blood tests are used so blood calcium does not fall too low

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Lower Your Other Risks

Quitting smoking, managing diabetes, and reviewing long-term steroid use with your doctor all help reduce the risk

📈So How Worried Should You Be?

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At osteoporosis doses, MRONJ is very rare

Reported rates vary, but they are all around 1 to 2 people in 1,000 or lower, and far below the rates seen with the high doses used in cancer care. The benefit of continuing treatment to prevent fractures is generally considered greater than this risk, and if MRONJ does occur, finding it early allows your dentist or oral surgeon to manage it. There is no need to be overly frightened.

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The one thing to avoid is stopping your medication on your own
Denosumab (Prolia) in particular has been reported to lead to more spinal fractures when it is stopped or when the next injection is badly delayed. For bisphosphonate tablets, current guidance also does not recommend pausing the drug for an extraction. If a dentist tells you to stop your medication, please contact us before you stop it.

🦷Before Your Dental Visit

💡 Five Things to Remember

Tell your dentist the drug name, how long you have used it, and whether it is a tablet or an injection (bringing your medication record is easiest)
Once an extraction is scheduled, share that with your orthopedic doctor as early as you can
If your dentist asks you to pause the medication, contact us before you stop it
Keep having your mouth checked and cleaned once or twice a year during treatment
Never stop your medication on your own. Keep protecting your bones from fractures and your mouth healthy at the same time

Osteoporosis Drugs and Dental Care

At osteoporosis doses, MRONJ is very rare

💡 Five Things to Remember

🩻 Gotokuji Orthopedic Clinic