Do you take Fosamax, Actonel or Boniva? What You Need To Know Before Having Dental Implants

Dental implants can be problematic if you take Fosamax, Actonel or Boniva. Contrary to popular opinion, This does not mean you cannot have dental implants, sinus lifts or bone grafts just because you take or have ever taken these medications called “bisphosphonates.”

Need Dental Implants, but Also Take Bisphosphontates?

For more than a decade, I have safely placed dental implants on patients who take or have taken these medications.

Oral bisphosphonates like Fosamax , Actonel and Boniva  are commonly used for the prevention and treatment of osteoporosis.  They work by preventing bone breakdown and increasing bone density (thickness). 

This sounds great, but when having a dental implant, bone graft or extraction, you need to have both types of cells that make bone and remove bone to heal normally.

Your risk involving dental implants

Having been treated previously or currently using bisphosphonate drugs you should know that there is a risk of future complications associated with dental implants, bone grafting or oral surgery treatment.  Fosamax type drugs appear to adversely affect the ability of the jawbone to break down or remodel itself thereby reducing or eliminating its ordinary excellent healing capacity.

This risk is increased after surgery, especially from tooth extraction; implant placement or other “invasive ” procedures that might cause even mild trauma to bone. 

The risk is significantly higher in patients who have received the injectable (IV) forms of these drugs.

Osteonecrosis may result.  This is a smoldering, long-term, destructive process in the jawbone that is often very difficult or impossible to eliminate.  The bone becomes exposed in the mouth and the gum doesn’t heal over it.

Fortunately this complication is fairly uncommon and happens in only about 1% of cases.  I have personally seen it.  It is most common in the lower jaw as opposed to the upper jaw.  The risk of osteonecrosis after having an implant is increased if you have been taking it longer than 3-4 years.

Fosamax , Actonel and Boniva  last in your bone long after you stopped taking it.  It may last in your bone for 10-50 years!

Make Sure Your Implant Dentist Knows Your Medical History

Your medical/dental history is very important to me.  Let me know if you take or have taken Fosamax , Actonel and Boniva before a sinus lift, bone graft or dental implant.  I may write you a prescription to have a special blood test to check your risk before we start. I may consult with your medical doctor to modify your regimen. It is critical to use a very knowledgeable implant dentist when you have taken these types of medications because there are many other factors that can cause problems not listed above.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow of the American Academy of Implant Dentistry
Burbank, California
Voted Best Dentist in Burbank -2006, 2008, 2010, 2011
www.burbankdentalimplants.com


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24 thoughts on “Do you take Fosamax, Actonel or Boniva? What You Need To Know Before Having Dental Implants

  1. Judy

    Dear Dr. Amin, DDS

    A Conundrum – (thank you in advance for any comments)

    Problem, she bites down overnight and her upper gums/mouth… are very sore.

    My mom is 92 and in a nursing home. Her front lower 8 teeth are failing (a few are loose the other really don’t serve a purpose and they are sharp) the xrays showed there is no infection. She no longer has teeth on top and won’t wear dentures. We are considering pulling all the teeth on the bottom?
    She won’t tolerate a mouth guard, (she’s quite nervous and we won’t get new dentures).

    Conundrum II: She took a BONIVA pill once a month for 2 1/2 years, from 8/06 stopped in 2/09. O oh:(
    The nursing home wants to do a CTX test, but I’m not sure we should go through with it, requires fasting?!

    She has good appetite and her health is fair but is confined to a wheelchair. I give her lunch every day, she eats soft foods.

    I, daughter, am beside myself as to what to do.

    Thank you very much if you take the time to answer. Thank You!
    Trudy

    P.S. – As long as the roots don’t get infected, maybe we should just leave them alone and hope the come loose?!

    Reply
    1. RamseyAminDDS Post author

      since she discontinued in 2009, she is unlikely to have a problem. The chance of developing osteonecrosis secondary to Boniva treatment at this point has decreased significantly. If she takes steroids such as prednisone for a long time that could increase her risk but it sounds like she doesn’t. If there aren’t any other medical complexities your likely okay to remove the teeth and not likely to develop the complication.

      Reply
  2. Keith Duggan

    Dear Doctor
    If I were living in California I would call in for a consultation but I am living im England.
    I would greatly appreciate your opinion on the following.

    I am 66 year old male who had a first impant (UL 4 ) in August 2009 and a second implant (UL 2)
    in Jan 2011. Subsequently (March 2015) I was diagnosed with osteopororsis and started taking bisphosphonates November 2015, orally. After several months, starting April 2016, I occasionally
    experienced a brief sharp pain in the area above the implants; approximately every 2 or 3 weeks.

    My thoughts were that there was some reaction happening between the implants and the bisphosphonates.
    In your opinion is this likely to settle down or would some investigation (more x-rays) be needed ?

    Many thanks in advance.

    Reply
    1. RamseyAminDDS Post author

      I would take some more x-rays at this point just to double check everything. The fact that you have osteoporosis means you are losing more bone than you are making every day. Your bone changes every single day and that is necessary for the health and function of your dental implants and natural teeth. Most people do not have problems if they take bisphosphonates after implants have already been there and healed in the years past.

      Reply
  3. Linda Morrison

    Dear Doctor
    I live in England i am 63yrs old I been on actonel and bonviva from 2001to2010 I have since been on calcium and vitamin D supplements 1in a morning and 1at night for the last 5yrs.I have a loose tooth (been loose for last 18months)also some bone loss in upper left and lower right back teeth when I had a full mouth x Ray done.My dentist seems to think I should be ok to have it out because I have been off them for 5 yrs he has never offered any of the blood tests you speak about (what are these tests called and what would I ask for).I have tried speaking to my doctor but she just says it’s a dental problem . I am at my wits end in trying to do the right thing.I was not informed of these problems when I was put on the medication .My doctor is wanting to put me back on them I am classed as borderline osteoporosis ,but I am not sure I want to go back on them .Is there anything else I could take without these side affects .I would truly appreciate your opinion on this thank you .yours sincerely Linda Morrison

    Reply
    1. RamseyAminDDS Post author

      after being off the medications for 5 years your risk is reduced. This is especially true because you took only oral medications rather than intravenous medications. Talk to your dentist about this but you should likely be okay.

      Reply
  4. Mike Moran

    Dear Dr. Amin,

    I’m in Maryland or I would come to see you. I’m 69 years old and in very good health but I had osteoporosis because of an overactive parathyroid, which was removed 8 months ago and my PTH is normal. I have been taking alendronate once a week for 1 year. I know that’s not a lot compared to some, but I still see dentists at drbicuspid.com etc. saying that someone in my shoes should “limit implants”, which I guess means, Don’t have them at all. But I need lower-jaw extractions and if possible, implants.

    I didn’t even know about CTX until I read your webpage. I wanted to take your advice about determining if I’m at low, medium or high risk for BRONJ.

    I stopped taking the alendronate two weeks ago. (I haven’t fallen in years.)

    Before I start the dental work I would like to get a serum-CTX test this week, and again 30 and 60 (and 90? and longer?) days from now, until my CTX is over 150pg or ???pg, or whatever you say I can hope for?

    Your answer to one patient in this thread, with Fosamax for 10 years, recommends also testing for bone turnover markers. Should I do that too, and what do I ask for? There seem to be a lot of names for that. And what are acceptable values for bone turnover markers?

    Thank you so much for any help you can give me. Without you, I’d know nothing about CTX.

    Sincerely, Mike Moran

    Reply
    1. RamseyAminDDS Post author

      Thank you for your very kind words.

      I would retest her CTX no earlier than 90 days. 30 days is far too early for there to be a significant change. Once you enter the safe zone you have a lower chance of having a problem. The higher the number a better.

      Bone turnover markers will test your ability to make bone which is extremely important. The CTX does not do that. There are test that can be done such as a bone specific alkaline phosphatase which can be helpful. The main thing is that your dentist knows how to interpret these. Just because you have the test and it is normal, it needs to be related to other things such as the CTX and other osteoporosis related measuring systems. One test does not do it all.

      The NTX is another good marker which is similar to the CTX.
      It is a good thing that you know about parathyroid.

      Using your own blood platelet concentrates such as L PRF and PRP will also help. Having intravenous sedation with intravenous steroids will also help you heal. There is more to good results and avoiding Fosamax complications than just CTX values.

      Very respectfully,
      Ramsey Amin DDS

      Reply
  5. Alex Chan

    Dear Dr. Amin, Would answer two questions for me if possible, I have been taking fosamax for 10 years. According to your article, I have no chance of having dental implant. Is that a correct conclusion? If I do want dental implant in case, is mini dental implant a safer and valid procedure for patient with both upper and lower denture?

    Reply
    1. RamseyAminDDS Post author

      Hello Alex,

      That is an incorrect conclusion.

      Just because you have taken a bisphosphonate call Fosamax for 10 years does not eliminate your chance of having a dental implant. Mini dental implants are not advised…. They bend, break and I really consider them temporary. Should have standard, normal diameter implants placed.

      2 or 3 values from a simple blood test can determine whether or not you are low, medium or high risk for developing osteonecrosis of the jaw secondary to bisphosphonate use. Not only should a CTX be done but also bone turnover markers should be measured to make sure you will grow bone.

      Lower jaw always carries more risk than the upper jaw. You can also take a drug holiday and switch to a different type of medication such as Forteo if you need to really be on Fosamax for 10 years or more. Most people that have been on this medication for 2-4 years were taken off because the drug lasts 10-15 years inside of the system. That begs the question, why continue to take it? I suggest you speak to your medical doctor and a really good implant doc.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  6. Diane Lawrence

    I took Fosamas 21/2 years, Boniva, Actonel and Reclast (IV). My bones are becoming brittle and my teeth have loosened. Now my four front teeth need to be extracted. I am very feared of ONJ. When I go to the dentist and he measures some of my teeth are measuring 11 and are now to the severe stage. I have been off meds for 41/2 years, but I am scared to have teeth pulled.

    Reply
    1. RamseyAminDDS Post author

      You did not mention of whether these are upper teeth are lower teeth. Typically the upper teeth have less chance of developing this complication.

      Reply
  7. Noreen Case

    I have 3 atraumatic compression fractures in my thoracic and lumbar spine, my bone density in October revealed osteopenia. I already had a fixed lower jaw bridge implant done 4 years ago.I was planning on getting upper dental implants, the dilemma is per my endocrinologist, orthopedist and pcp all feel I need to take a biophosphate can theses implants be safely done?

    Reply
    1. RamseyAminDDS Post author

      Do the dental work first before going on the medications if possible. But keep in mind if your osteoporosis is severe this may inhibit your ability to heal after dental implants in the upper jaw. It is a double edged sword.

      Reply
  8. Diane

    I sure need some help. I was on boniva for 8 years then was switched to generic one. I went off it last april 2014 because I have a very painful tooth to be extracted.how soon willi be able to extract the tooth, please help

    Reply
    1. RamseyAminDDS Post author

      There is no way that I can answer this for you without some blood tests. Your dentist needs to evaluate your risk for developing osteonecrosis of the jaw from taking Boniva. These medications are called bisphosphonates. There are also other medications that act like a bisphosphonates such as Prolia which can have the same affect.

      There are blood test available that I can tell you your risk for developing osteonecrosis. There are also blood test available to know how you breakdown bone and how you build bone. This is more involved than just taking a CTX blood test. This is especially important for your lower jaw and especially important if you have been on these medications for a long time.

      If you are my family member, all of these tests would be run before doing any treatment. There are very simple, fast and inexpensive. The main thing is that your safe. You do not want to have this horrible complication which can lead to losing part of your jawbone even.

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
    1. Ramsey Amin DDS

      Hello Renee,

      There is no way that I can answer this for you without some blood tests. Your dentist needs to evaluate your risk for developing osteonecrosis of the jaw from taking oral Fosamax. These medications are called bisphosphonates. There are also other medications that act like a bisphosphonates such as Prolia which can have the same affect.

      There are blood test available that I can tell you your risk for developing osteonecrosis. There are also blood test available to know how you breakdown bone and how you build bone. This is more involved than just taking a CTX blood test. This is especially important for your lower jaw and especially important if you have been on these medications for a long time.

      If you are my family member, all of these tests would be run before doing any treatment. There are very simple, fast and inexpensive. The main thing is that your safe. You do not want to have this horrible complication which can lead to losing part of your jawbone even.

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
  9. Erika Stellato

    One of my teeth needs gum grafting. I saw a specialist for gum grafting and was told of some of the risks. I took boniva two years ago, got off for a while and went back on it three months ago. All together I took it 18 months. I am 69 years old, in excellent health and 4 cleanings a year. I am petrified and don’t know what to do. Any advice is greatly appreciated.
    Erika Stellato

    Reply
    1. RamseyAminDDS Post author

      if you are petrified go ahead and take some of the blood tests that I have suggested to others in other comments. This would be test like the CTX, NTX and bone specific markers.

      Reply
    1. Ramsey Amin DDS

      Hello Doctor,

      I would suggest waiting 3-4 months. Get a new DEXA bone scan and bone turnover markers to determine is going back on Fosamax is even needed!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      Reply
    2. Sheryl

      I had bone graft and dental implants 4 years ago. Now have been perscribed Risedronate to prevent future bone loss . Can I safely take it or will it cause a problem with existing implants?

      Reply
      1. RamseyAminDDS Post author

        It should not be a problem. It is a good thing it had the implants done already.

        It is only a problem if you need surgery. Once the implants are placed, everything is fine

        Reply