Osteoporosis causes bones infection may be difficult to heal. ONJ does not affect Osteoporosis Medications, to become weak and break the jaw joint (temporomandibular joint or TMJ), and Dental Health, and (fracture) easily. These pain or discomfort in the jaw joint is not related to fractures can happen from ONJ or to bisphosphonate or denosumab treatment. Osteonecrosis of the Jaw simple falls or even from Though sometimes painful and progressive, ONJ can usual day-to-day activities be present without symptoms; it usually heals with (ONJ): (eg lifting, bending). Any appropriate treatment. bone can fracture with What You Need to Know osteoporosis; however, the How is ONJ Diagnosed? most common fractures are of the spine, hip, and Dentists or oral surgeons can diagnose ONJ by wrist. Osteoporosis can affect men and women of all examining the soft tissue covering the jaw bones. If ages but is most common amongst women after the jaw bone is not covered by a healthy soft tissue menopause. lining and remains uncovered or exposed for more than 8 weeks of appropriate treatment, this confirms Fractures from osteoporosis are preventable with the diagnosis of ONJ. appropriate medications. Bisphosphonates are a class of drugs which can safely and effectively ONJ can occur in the general population in the decrease the risk of fracture in osteoporotic patients. absence of any bisphosphonate or denosumab They represent a major advance in the treatment of therapy or other drugs, and usually heals within 12 osteoporosis and other bone diseases. Some of the weeks. ONJ can also develop in people who have risk oral bisphosphonates which are commonly factors for ONJ including poor blood supply to the prescribed include alendronate (Fosamax, Binosto), bone cells in the jaw. It can also develop after major ibandronate (Boniva) and risedronate (Actonel, dental surgery which involves cutting the bone, Atelvia)). Zoledronic acid (Aclasta, Reclast) given chemotherapy, steroid therapy (such as prednisone) intravenously once yearly is also used for and from poor dental health and diabetes. osteoporosis. Bisphosphonates remain in the skeleton for several years even after they are stopped. Bisphosphonates help reduce the risk of Is ONJ Caused by the Osteoporosis Therapy fracture and help maintain healthy bones. -- Bisphosphonates or Denosumab? Brought to you by Denosumab (Prolia) is also an effective treatment for ONJ has been noted in patients with cancer receiving the International Task Force on ONJ osteoporosis and can effectively lower the risk of high doses of intravenous zoledronic acid or fracture. Denosumab is given twice yearly by denosumab to reduce the complications associated subcutaneous injection and does not remain in the with cancer that has spread to the bones. In these skeleton for prolonged periods of time. patients, the risk increases with higher doses and with longer duration of treatment. In patients with What is Osteonecrosis of the Jaw? cancer, ONJ has been estimated to occur in 1 to 15% Osteonecrosis of the jaw (ONJ) is a rare oral of individuals receiving high dose bisphosphonate or condition in which the jaw one’s ability to heal is denosumab therapy. impaired and may cause a wound which does not heal. The bone is bare and is not covered by the oral In patients with osteoporosis, denosumab or tissues. bisphosphonate medications are used in lower doses (much lower than in patients with cancer) and the This bare bone can become infected and lead to pain risk appears to be only minimally higher then seen in and swelling. The bone can then break and the the general population not taking any bisphosphonates and denosumab are extremely Laurie K. McCauley, Felie O’Ryan, Ian R. Reid, bisphosphonate or denosumab therapy. The risk of important in preventing fractures, this should be Salvatore L. Ruggiero, Akira Taguchi, Sotirios ONJ with low dose bisphosphonate or denosumab discussed with the health care provider who Tetradis, Nelson B. Watts, Maria Luisa Brandi, treatment in osteoporosis patients is estimated to be prescribed the osteoporosis treatment. Edmund Peters, Teresa Guise, Richard Eastell, Angela between 1 in 10,000 and 1 in 100,000 per year of use M. Cheung, Suzanne N. Morin,Basel Masri, Cyrus and appears to be increased only slightly, if at all, How is ONJ Treated? Cooper, Sarah L. Morgan, Barbara Obermayer- compared with the risk for ONJ in the general If ONJ does occur, treatment is usually managed by Pietsch, Bente L. Langdahl, Rana Al Dabagh, K. population who have not taken any osteoporosis the dentist and/or oral surgeon and includes Shawn Davison, George K. Sándor, Robert G. Josse, therapy. maintaining good oral hygiene, controlling pain and Mohit Bhandari, Mohamed El Rabbany, Dominique treating areas of infection with antibiotics and oral D. Pierroz, Riad Sulimani, Deborah P. Saunders, How can ONJ be Prevented? antibiotic mouth rinses. Making sure patients take Jacques P. Brown, Juliet Compston on behalf of the The International ONJ Task lots of fluids and appropriate nutrition is also International Task Force on Osteonecrosis of the Force recommends that necessary. In certain circumstances, surgical Jaw. Case-Based Review of Osteonecrosis of the Jaw everyone should maintain treatment is required to remove dead bone tissue. (ONJ) and Application of the International good oral hygiene and see This will be determined by the dentist and oral Recommendations for Management From the their dentist every 6 months surgeon. International Task Force on ONJ, published in J. Cli. (or as recommended based Desito., 1-17, 2017 Additional Task force on oral disease risk). Routine Summary: members are: Ethel Siris, Sakae Tanaka, Bo dental work, such as dental The International Task Force on Osteonecrosis of the Abrahamsen and Akira Itabashi cleaning, fillings or root Jaw has been established to look at research canals should be performed as usual and do not priorities in order to help us understand the causes require stopping your osteoporosis treatment. It is of ONJ as well as the most effective forms of important to stop smoking. If possible, before treatment. starting high dose intravenous bisphosphonate or denosumab therapy in patients with cancer, a Osteoporosis is a serious disease. Treatment with detailed dental examination should be completed bisphosphonates or denosumab is a safe and with Xrays of the jaw bones. Any necessary dental effective way to reduce your chances of breaking a surgery should be completed before starting high bone. Talk to your doctor about your concerns and dose intravenous bisphosphonate or denosumab make sure your dentist is aware if you are taking a therapy in patients with cancer. The bisphosphonate or denosumab. recommendations for patients with osteoporosis receiving low dose bisphosphonate or denosumab If you are experiencing any of the following therapy are similar to those which apply to all symptoms please contact your dentist: individuals. They include maintenance of good oral Infection of the gum, drainage of the gums, poor hygiene and visiting your dentist regularly. If oral gum healing, numbness of the jaw, jaw pain or surgery is needed, it is ideal to have the surgery swelling or bare bone in the mouth. completed before starting low dose oral or intravenous yearly is phosphonate therapy or A JOINT MESSAGE FROM denosumab therapy if possible. Individuals with risk The International Task Force on ONJ : ASBMR, factors for ONJ who are taking bisphosphonate or AAOMS, CAOMS, CAOMP, ECTS, IBMS, IOF, ISCD, denosumab therapy may be advised to stop IAOMS, JSBMR, NOF, Osteoporosis Canada , PAOS, treatment after dental surgery and to restart therapy TES Aliya A. Khan, Archie Morrison, David L. Kendler, after the surgical site has completely healed. This Rene Rizzoli, David A. Hanley, Dieter Felsenberg, usually takes place 1-2 months after the surgery. As .