Thank you for your post concerning the problems you are experiencing accessing dental treatment and whether an alternative medication to your alendronic acid or alendronate (Fosamax) would be a viable option.

The issue of having an extraction whilst taking a bisphosphonate (the group of drugs alendronic acid belongs to) relates to a very rare condition called osteonecrosis of the jaw (ONJ). More information on ONJ is in the charity’s ‘Drug treatments for osteoporosis’ leaflet on pages 13 to 15).

My initial response to this would be that unless you also have a specific health problem (see below), simply taking a bisphosphonate medication for osteoporosis would not be sufficient reason for a dentist to decline performing a routine extraction. This is because your risk of developing osteonecrosis of the jaw (ONJ) would be considered very low. This decision would be based on currently available evidence and follows recommendations published in the very latest guidance about the dental management of patients on bisphosphonates (Scottish Dental Clinical Effectiveness Programme (SDCEP) April 2011). The health problems mentioned above, applies to individuals who are currently receiving chemotherapy/ radiotherapy, corticosteroids, or medications that lower or reduce immunity. More significantly, it applies to people who are taking bisphosphonates in higher doses for the management of cancer.  In these situations it may be appropriate for a dentist to seek advice from a specialist oral surgeon about the advisability of an extraction or any dental treatment which impacts on the jaw bone (and if necessary referring the individual in question to the hospital for the treatment).

You ask about alternative treatment options, there are certainly non-bisphosphonate drug treatments which are listed in the leaflet mentioned above. However, it is debatable whether your doctor (in the absence of any real risk factor) would consider this a valid enough reason for offering you an alternative treatment.

Bisphosphonate use and ONJ is a much discussed issue not only on the forum but also on the helpline. Unfortunately we regularly hear about people who appear to be getting inappropriate advice from their dentists, this can result in unnecessary delays in getting dental treatment, increased pain and personal expense. In some situations an individual’s risk for fracture may even be increased if as a result, they decide to discontinue their treatment.


Best wishes

Helpline Nurses
National Osteoporosis Society

The post above numbered #7295 is the reply from the helpline nurses to the question about dental extractions and taking alendronic acid.

Best wishes

Helpline Nurses
National Osteoporosis Society