Dental implants in patients taking Fosamax and similar meds (bisphosphonates)

Dr. Robert Marx recently had a great article in the JIRD on bisphosphonates and how it relates to implants.

As some may know, Post-menopausal women make up a significant portion of our patient population seeking dental implants, to replace removable partial or full dentures.   This population is also typically on medications, such as bisphosphonates, to treat or prevent osteoporosis.

Oral bisphosphonate medications inhibit osteoclastic activity, meaning they prevent the function of osteoclast cells that typically destroy bone.  Interestingly, osteoclasts play a critical role in deposition of bone by another cell, called: osteoblast.  Without the inter-play of these two types of bone cells, a patients bone physiology is altered…for the better to worst.  Thus patients who are taking such drugs may be at risk for developing “bisphosphonate-induced osteonecrosis of the Jaw (BIONJ) following dental extractions and/or placement of dental implants.  For that reason, some have suggested that osteoporotic women receiving bisphosphonate therapy may not be good implant candidates.  This is where it gets complicated….not all bisphosphonate medication have the same profile, meaning just taking oral bisphosphonates does not preclude you from getting an implant.  It depends on which bisphosphonate (oral vs. IV form), the duration and the amount of the medication that is ingested prior to surgery.

Among the 3 most commonly prescribed oral bisphosphonates- Actonel, Boniva and Fosamax…Fosamax is the only one of major concerns.  Fosamax is typically given at twice the dose of the other two medications and has been associated with a greater incidence of BIONJ.  Among Dr. Marx’s patients, Fosamax accounted for 97% of such cases.  Hence, patients who are taking either Actonel or Boniva can be treated essentially like any other patient receiving an implant.

For those taking Fosamax, the length of treatment should be considered: How long has the patient been on Fosamax?  Those who have taken it for 2 years or less appear to have normal bone healing when it comes to implants.  If taken for more than 2 years, the risk of BIONJ appears to increase with time.  Since Fosamax affects mature osteoclasts, as well as immature or young osteoclasts in the bone marrow, it usually takes 2 or more years of Fosamax to reduce the mature osteoclasts enough to affect osseointegration of implants.  Remember, osteoblast are needed for the implant to osteointegrate.  Below is the actual article: