Osteoporosis meds must be paused before oral surgery

Dr. Keith Roach

Dear Dr. Roach: Help! I am caught in a feud between my primary care doctor and my oral surgeon. For a number of years, I have been on Prolia for osteopenia. About a year ago, I had to have a tooth pulled; my oral surgeon said I must be off Prolia for at least four months; my doctor disagreed, saying it is more risky to stop the Prolia. I feel a bit like a ping-pong ball between the two of them and need some guidelines on Prolia and dental work.

— Anon.

Dear Anon.: The concern here is of a condition called osteonecrosis of the jaw. This is a rare (around one person per 10,000 taking Prolia, or a similar medicine, for 10 years) condition causing pain and swelling of the jaw, which can lead to exposed bone, infection and fracture of the jaw.

Whenever possible, a comprehensive dental evaluation should be done before a person starts on this kind of medication. Also, whenever possible, extractions and implants should be deferred. But sometimes that just isn’t possible, and the procedure needs to be done while on the medication.

The American Association of Oral and Maxillofacial Surgeons suggests performing surgery, such as extractions and implants, as usual in patients who have been treated with Prolia or similar drugs for less than four years and have no clinical risk factors. It also suggests discontinuing the osteoporosis medicine for two months prior to performing the dental surgery if a patient has been treated with it for more than four years, or has been treated with steroids. Osteoporosis medicines are restarted when the bone has healed.

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