Is Bisphosphonates treatment like Zoledronic Acid 5 mg injection good or bad for bone fractures?

[smtkrgsl]

The lower denture of my mother aged 79 years does not fit properly because of gum recession. The maxillofacial surgeon in India recommended her denture implantation. But when I told the doctor that she has taken the 3rd injection of Stoplos One (zoledronic acid) in India on 28.09.2019 and the 1st injection of Olimab (Denosumab) on 01.03.2020, he refused to do the denture implantation as he said it will lead to osteo-necrosis of the jaw or any other serious damage to the bone.

My mother’s recent Bone Mineral Density Test done on 23.02.2020 shows the following:

Site Region T-Score BMD

Left forearm Radius 33% -4.9 0.450g/cm2

Right forearm Radius 33% -3.5 0.573g/cm2

Dual Femur Neck Left -1.7 0.797g/cm2

Dual Femur Neck Right -1.9 0.780g/cm2

AP Spine L1 - L4 -1.4 1.006 g/cm2

The orthopedic doctor has prescribed Olimab S.C. 60 mg injection (Denosumab) found in India . He also prescribed to continue Stoplos One (Zoledronic acid) for 2 more years. My mother has already taken Bonmax Pth (teriparatide) injection for 2 years from October 2015 to September 2017 and Stoplos One (zoledronic acid) for 3 years from October 2017 to October 2019.

I want to know now whether Bisphosphonates like zoledronic acid increases the risk of fractures, irregular heart beat and osteonecrosis of the jaw. Does zoledronic acid suppress bone remodeling which is supposed to stop bone loss. Does low bone density increases the risk of fractures or it is not? A YouTube video on “The end of Osteoporosis” says that Bone Mineral Density is not a good predictor for fractures. Bone density does not equal bone quality. According to the video low bone density does not increase the risk of fractures. Osteoporotic fractures may happen to persons having good bone mineral density.

[HeronNS]

I replied with what little I know on the Patient forum. This forum is great, but you will find a lot more members on the Bone Health Forum so you may get more replies, so please consider posting there too.

healthunlocked.com/bonehealth

[Met00]

I'm not a medical expert, so anything I say is my point of view and not necessarily correct for your mother. I have to say, though, that I'm surprised she's been put on so much medication and wonder whether she's had fractures to justify this? Her spine and hip t-scores, which are the ones that are usually used, are only osteopenia, not osteoporosis. I don't know how accurate forearm scores are, but it does seem strange to me that those 2 scores would be so different from her spine and hip scores. Having said all that, if she's had fragility fractures, then she would be classed as having osteoporosis, and if she's continued to fracture, despite medication, that might explain why she's now being prescribed 2 different medications. Can I encourage you to speak to her doctor about this, as he/she is the best person to explain the treatment.

As far as bisphosphonates are concerned, yes, there is a very small risk of osteonecrosis of the jaw, and for this reason most, if not all, dentists refuse to do implants. I don't think they'd be prepared to do this, even if your mother stopped the medication, because it has a long-term impact on the bones. I was told that I would have to be off bisphosphonates for at least 3 years before my dentist would consider giving me an implant. I believe there's also a risk of jaw osteonecrosis from denosumab, and you also need to be aware that, if your mother stops taking denosumab, she needs to stay on bisphosphonates (I think for at least a year) to reduce the risk of rebound fractures.

[Mark_ABH]

This is all basically correct, and it's something we emphasize in our educational materials and programming >>> "A YouTube video on “The end of Osteoporosis” says that Bone Mineral Density is not a good predictor for fractures. Bone density does not equal bone quality. According to the video low bone density does not increase the risk of fractures. Osteoporotic fractures may happen to persons having good bone mineral density."

Has she already had fractures? Denosumab typically is prescribed after someone has already had fractures. However, it is vital that a patient take a bisphosphonate after discontinuing denosumab (Prolia).

Here is more information on zolendronate (marketed in the U.S. as Reclast): americanbonehealth.org/medi...

And here is the American Dental Association guidelines on BPs and ONJ risk (Indian dentists might follow different guidelines, of course): americanbonehealth.org/oste...

And here is an article on how cancer patients can minimize the risk of ONJ. They take much larger doses of bisphosphonates than osteoporosis patients: americanbonehealth.org/medi...