Teeth, osteoporosis, alendronic acid

[apoetndoesntknowit]

Taking alendronic acid well, no problems, for just over 20 years, with a 1 yr long break, a few yrs ago. Then dexa showed density decline so put back on it. Both mother and aunt had total spinal collapse long over a decade of their latter years, and sister with it too.

I am upright and looking ok at 68, nothing like my family at this age, although I also have osteoarthritis, with no cartilage left in either knee now, working bone on bone, with high pain threshold that both blesses and curses. I have avoided knee replacements for what may seem obvious reasons. However, I try to just do each day, and enjoy it, while not letting tomorrow's potential spoil it.

Sadly, I've had 2 big back teeth fall apart during Covid19 lockdown, both mostly amalgamate filled. I'm not rushing to dentist, or anywhere at present, but feel that I should contact my consultant before any other practitioner. I don't feel my dentist should try any further work or repair until MRI, or other tests can show that my jaw is not at risk now.

Any advice, thoughts, comments will be appreciated.

Regards

[Mark_ABH]

Hello, apoetdoesnknowit! Here is more information from American Bone Health about the risk of osteonecrosis of the jaw due to taking bisphosphonate medicines (like alendronate) to treat osteoporosis. The reported incidence of ONJ due to oral BPs is between .01% and .001% ("one one-hundredth of 1 percent to one one-thousandth of 1 percent"). It is higher but still rare for IV medicines. americanbonehealth.org/oste...

(Note that having taken your alendronate for more than 2 years puts you at increased risk.)

Here are some guidelines from the American Dental Association. They cite a 2011 report that "concluded that the potential morbidity and mortality associated with osteoporosis-related fracture is considerable and treatment with antiresorptive agents, including bisphosphonates, outweighs the low risk of MRONJ in patients with osteoporosis being treated with these drugs." ada.org/en/member-center/or...

(Note that the recommendations are based on expert opinion because the dentists don't have much data to go by.)

You should mention your tooth loss to the doctor who prescribes your alendronate and let your dentist know before you get any more work done.

Glad to hear the alendronate seems to be doing its job for you!

[apoetndoesntknowit in reply to Mark_ABH]

Thanks Mark. Original consultant who prescribed alendronate is retired now, so now many and varied opinions come into play. Having my mother and her sister in a very bad way, with totally collapsed spines for at least the last decade of their lives, has been a caution to me. As I said previously, during my year of not taking it, my bone density did go into decline, as shown by the dexa scan I had then, so I was put back on it. However, I have different GP opinions about continuing to prescribe, so I intend to return to a consultant for more in depth consideration next time that happens.

Teeth have settled since I lost those two lost fillings. No pain or further problems during COVID19 lockdown, so keeping all clean and awaiting a time I can feel safer to approach dentist when available again here in UK. It's all about juggling probability and risk these days, I guess.

Thanks for your reply.