Osteoporosis & Osteonecrosis

Patients with osteoporosis may experience oral changes, such as:

  • Increased tooth loss
  • Additional denture adjustment as jaw shape changes


  • IV bisphosphonates are associated with osteonecrosis of the alveolar bone
  • Prevalence is rare, at approximately 0.1%
  • Can occur at the site of a tooth extraction or spontaneously
  • American Dental Association recommends regular dental care for patients on bisphosphonates
  • Discontinuing bisphosphonates may not lower the risk, but may negatively impact low bone mass treatment

Symptoms of Osteonecrosis

  • Jaw pain
  • Swelling and infection
  • Loosening teeth
  • Drainage and exposed bone
Alan Lurie, DDS
Alan Lurie, DDS
John McDowell, DDS
John McDowell, DDS
Ricardo Padilla, DDS
Ricardo Padilla, DDS
John McDowell,DDS
John McDowell,DDS


Hellstein JW, Adler RA, Edwards B, et al. Managing the Care of Patients Receiving Antiresorptive Therapy for Prevention and Treatment of Osteoporosis: Executive Summary of Recommendations from the American Dental Association Council on Scientific Affairs. JADA. 2011; 142: 1243-1251.

Edward BJ et al. Osteoporosis and its implications for dental patients. Journal of the American Dental Association 2008; 139(5): 545-552.

Jeong HG, Hwang JJ, Lee JH, Kim YH, Na JY, Han SS. Risk factors of osteonecrosis of the jaw after tooth extraction in osteoporotic patients on oral bisphosphonates. Imaging Sci Dent. 2017; 47(1): 45-50.

Ruggiero, S et al. Medication-related osteonecrosis of the jaw-2014 update. American Association of Oral and Maxillofacial Surgeons. Accessed on 9/20/2021.