prolia and osteonecrosis?

[composition]

Has anyone had a dentist tell them if they are on prolia injections, they run the risk osteonecrosis with dental surgery/implant?

[PMRpro Ambassador]

The claimed risk of poor bone healing is well known for all bisphosphonates - and apparently Prolia counts as one. Many dentists simply refuse to treat patients on such bone protection medications and say they must have extractions done in hospital although some experts say it isn't as bad as it is painted.

However, this

qeios.com/read/D95OWG

may be of interest to your dentist if they are trying to get out of doing implants. This group suggests doing the necessary work in the month before the next dose is due.

[Hidden in reply to PMRpro]

Thanks for link. Have saved. Reassuring. You always are such a great resource and your willingness to share is appreciated. 😊

[Marilyn1959]

My Rheumy wanted me to go onto annual injections to protect bones, stating 'Your teeth need to be in good order though!' Pigs may fly then I thought.

I discussed this with my dentist since my teeth were troublesome and over the past 3 years been gradually having all my teeth out much to the dismay of my dentist. (Though he doesn't feel my pain caused by gum /tooth persistent infections).

I also have had one day surgery in hospital for 'crumbling jaw' pre PMR, so am considered high risk for osteocronosis if I have bone meds. I may also need implants to act as point on which full dentures can grip, since I have little ridge in my gums. Therefore I am still very much in a dilemma.

I hope to have remaining teeth out after a cancelled appointment a couple of weeks ago. After a couple of months we will know if I need implants, but may need surgery to rebuild ridge. By which time I will be eligible for a biannual dexa scan, when we may / may not decide to have bone meds.

However, had I not questioned and looked at the totality of my personal history, each practitioner was only interested in their area regardless of total picture. Even still my dentist argues against having my teeth out, and my Rheumy pushing for bone meds three years on. Oh that there was a way of them all communicating and working in the best interest of the patient together!

🤯🤯🤯

[PMRpro Ambassador in reply to Marilyn1959]

Reading the contraindications might be a start!!!

[Marilyn1959 in reply to PMRpro]

I am just glad I am mentally competent and confident to insist each looks at the whole. I feel so sorry for the elderly who have no one to do that for them.

I remember saying that to my Mums consultant who said she should thank me not him when she had a pace maker fitted after I had to fight for it. All he could do was agree with me regarding the system. God help if I ever lose my mental capacity!

[PMRpro Ambassador in reply to Marilyn1959]

Is that in the UK? Here I had something of a fight for them to find it and I had the blackout I feared before they realised I was having prolonged pauses in heart beat which was what was doing it. But once that happened - no going home until you have a pacemaker. I was lucky - learned last night that my best friend's husband had a dizzy spell at the top of their spiral stairs, fell and broke his neck - result paraplegia which is resolving slowly after a month - one arm moves and he can feel hot and cold now. But he will be in rehab for 6 months and no promises how much he will recover. They haven't found why he had the dizzy spell - but I bet they haven't had him permanently on an ECG machine ...

[Marilyn1959 in reply to PMRpro]

Yes in the uk. They originally found it after she was hospitalised for five days. They yo yoed between meds or pace maker. Decided they would deal with it via meds, sent her home without meds, sent a nurse round following day who didn't know why they were there. It was dire! So dore that at one point I got a call to say she was having a pacemaker at 2pm. Went to hospital to find my mother gowned up with cannula ready to go but she eating her lunch! Absolutely diabolical. I demanded to see heart consultant within 10mins or the newspapers were going to have a field day. He did arrive and I got her transferred from general to heart ward but not a lot improved as she was discharged without promised meds and Follow up appointment with consultant in three months. So absolutely nothing had changed since her emergency admission some 5 days before!Needless to say I rang them, played b*****ks and asked for the name of the person (consultant) I should use, should my mother die before the three month consultation and therefore I needed to sue for negligence. Surprise surprise they had a cancellation the following day.

Even then he wanted her to return a week later to be fitted with 24 hour home monitor. I told him he needed to find one now! He did. Two hours after she returned the monitor she was asked to go back into hospital and Mum had her pacemaker the following day.

Unsurprisingly the hospital was slated in its inspection two months later for care for elderly, which hit national tabloids.

Your friends family need to push for the investigations. All too often the effect becomes the focus rather than cause. Mum was in her 70's and would often say Marilyn you have to expect these things at my age, however at that time my Mum was moving around like speedy Gonzales and was one of the sharpest tools in the box, so no one was putting her out to pasture!

I do hope they find the cause of your friends dizziness and that he recovers well.

[PMRpro Ambassador in reply to Marilyn1959]

No - his experience had no history - I don't think anyone can be held responsible in that sense. I always said our stairs in Germany were lethal!!! Quite narrow and spiral with wooden treads, oh so easy to slip on! But I don't think that was the cause.

[HeronNS]

In the interests of accuracy, Prolia (denosumab) is not a bisphosphonate, it is a monoclonal antibody. Although the risk is small it is increased slightly if you have dental surgery while on Prolia. The risk is higher for people who are being treated with zoledronic acid or Prolia for cancer. Got this info from quick google searches, very frustrating process as the results kept coming up different each time I did it (with same search terms) so I can't give the exact figures I first saw, or why the risk is higher for cancer patients than for those receiving for osteoporosis.