Fighting Osteoporosis
What most patients don’t realize, however, is that while bisphosphonates are beneficial for bone health, they can lead to serious oral health complications, including a rare but severe condition called jaw osteonecrosis.
In this article, we’ll break down:
- What osteoporosis is and what causes it
- How bisphosphonates work
- The potential impact of these drugs on your oral health
- What you can do to delay or avoid the need for bisphosphonates
Activities like yoga, Pilates, and dancing help improve mind-body coordination, enhance balance, and reduce the risk of falls
What osteoporosis is and what causes it
Osteoporosis is a systemic bone disease characterized by reduced bone mineral density and deterioration of bone structure, leading to increased fragility and a higher risk of fractures.
The most common fracture sites are the hip, spine, and wrists. Although it affects both men and women, women are more likely to develop it - roughly 1 in 4 women compared to 1 in 10 men.
Research shows that women lose about 30% of their bone mass after menopause.
The main causes of osteoporosis include genetic predisposition, hormonal imbalances (especially estrogen deficiency after menopause), nutritional deficiencies (low intake of calcium, vitamin D, and vitamin K), physical inactivity, smoking and excessive alcohol use, certain chronic illnesses (e.g., hyperthyroidism, celiac disease), long-term use of certain medications like corticosteroids.
Prevention starts with a healthy lifestyle: regular physical activity, a balanced diet rich in bone-supporting nutrients, and routine medical check-ups, especially with age or when risk factors are present.
What Are Bisphosphonates?
Bisphosphonates are a class of drugs used to treat osteoporosis. They work by slowing bone loss and reducing the risk of fractures, particularly in the hips, spine, and wrists.
Our bones naturally regenerate over time, going through a renewal cycle that happens about seven times over a lifetime. After reaching peak bone mass (around age 25–30), bone tissue continues to break down and rebuild in a balanced way - unless something disrupts the process.
With age, hormonal changes can throw off this balance, increasing bone resorption and decreasing new bone formation.
Bisphosphonates help by inhibiting bone resorption, essentially stopping the loss of bone tissue when the body can't rebuild fast enough.
Some scientific studies support bisphosphonates to be used preventively - especially for postmenopausal women or individuals with a significant drop in bone mineral density. They’re also recommended in patients undergoing radiation therapy, which can impair bone health by damaging the bone’s microvascular system.
While bisphosphonates have proven effective in managing osteoporosis, they also come with potential side effects, including jaw osteonecrosis, a serious oral health condition.
Oral Health and Osteoporosis: A Connection You Shouldn’t Overlook
One of the most concerning complications of bisphosphonate therapy is osteonecrosis of the jaw, especially the lower jaw. This can be triggered by:
- Chronic dental infections (e.g., abscesses at the root of a tooth)
- Advanced periodontal disease (commonly known as gum disease)
- Gum inflammation due to poor oral hygiene
- Infected dental implants
- Smoking, which worsens oral health
Because of this risk, it’s critical to get a thorough dental exam, before starting bisphosphonate therapy. This includes: 1. a panoramic dental X-ray and 2. targeted intraoral X-rays to rule out any hidden infections or existing conditions.
If you're already taking bisphosphonates, follow these essential steps:
- Maintain excellent oral hygiene
- Avoid or quit smoking
- Get professional cleanings on a regular basis
Why Consider Delaying Bisphosphonates?
Like all medications, bisphosphonates come with risks. Even though medications are essential in helping us fight disease, and even though science is constantly searching for less invasive treatments, it’s always best - when possible - to delay the use of medications through healthy lifestyle and preventive care. The goal is to support your bone health naturally for as long as you can, reducing or postponing the need for medication.
What You Can Do Before Starting Bisphosphonates
- Regular check-ups: See specialists who can monitor your bone health with tests like DEXA scans (bone density testing).
- Reduce risk factors: Quit smoking, limit alcohol, and manage chronic illnesses like diabetes or arthritis.
- Supplement smartly: If needed, supplement with calcium and vitamins D and K, especially if your diet isn’t providing enough.
The Role of Diet in Bone Health
A well-rounded, nutrient-rich diet is essential for maintaining strong bones. Key nutrients include:
- Calcium and protein: needed for bone strength and structure. Found in dairy products, meat, and legumes.
- Vitamin D: helps the body absorb calcium. Found in fatty fish, egg yolks, and synthesized through sunlight exposure.
- Vitamin K: helps bones retain calcium. Found in leafy greens, cheese, eggs, and soy.
Physical Activity and Fall Prevention
Exercise plays a major role in both bone health and fall prevention:
- Weight-bearing activities like walking, climbing stairs, or lifting light weights stimulate bone growth.
- Balance-focused activities such as yoga, Pilates, or dancing improve mind-body coordination and help reduce fall risk.
Oral Health and Bone Loss: A Two-Way Street
Tooth loss can sometimes be an early sign of bone density loss. That’s why good oral hygiene and regular dental visits are essential, especially if you’re at risk for osteoporosis.
Conclusions
Aging is inevitable, but physical decline doesn’t have to be. With the right lifestyle choices, you can slow down bone loss and stay healthier for longer.
Preventing osteoporosis through diet, exercise, and regular medical and dental care is key to maintaining quality of life as you age.
Take action early, because when it comes to bone health, every day counts.
Scientific literature
Com’è fatto l’osso?
https://www.siommms.it/area-pazienti/come-fatto-losso/
World Health Organization. (2003). Prevention and management of osteoporosis (WHO Technical Report Series, No. 921). Geneva: World Health Organization.
https://apps.who.int/iris/handle/10665/42841
Bone Health and Osteoporosis
https://www.niams.nih.gov/health-topics/bone-health-and-osteoporosis
Early menopausal changes in bone mass and sex steroids
https://pubmed.ncbi.nlm.nih.gov/3930555/
Osteoporosis
https://www.niams.nih.gov/health-topics/osteoporosis
Terapia precoce con bifosfonati per la prevenzione dell’osteoporosi e delle fratture
https://www.siommms.it/terapia-precoce-con-bifosfonati-per-la-prevenzione-dellosteoporosi-e-delle-fratture/
Medication related osteonecrosis (MRONJ) in the management of CTIBL in breast and prostate cancer patients. Joint report by SIPMO AND SIOMMMS
https://www.siommms.it/wp-content/uploads/2025/01/SIPMO-SIOMMMS-ONJ-250121.pdf
Zoledronato ogni 5 anni: una strategia efficace per prevenire le fratture dopo la menopausa
https://www.siommms.it/nejm/
Quali sono i principali fattori di rischio di osteoporosi?
https://www.siommms.it/area-pazienti/quali-sono-i-principali-fattori-di-rischio-di-osteoporosi/
Quali sono le cause dell’osteoporosi e quali le misure preventive?
https://www.humanitas.it/news/quali-le-cause-dellosteoporosi-quali-le-misure-preventive/
Prevenzione: consigli pratici per vincere l’osteoporosi
https://www.humanitas.it/news/prevenzione-consigli-pratici-per-vincere-losteoporosi/
Osteoporosi: perché curarla e cosa prevede il trattamento?
https://www.humanitas.it/news/osteoporosi-perche-curarla-cosa-prevede-trattamento/
How does medication-related osteonecrosis of the jaw (MRONJ) influence the health-related quality of life after surgery?
https://pubmed.ncbi.nlm.nih.gov/40544272/
Osteoporosis Management after the Occurrence of Medication-Related Osteonecrosis of the Jaw: A 13-Year Experience at a Tertiary Center
https://pubmed.ncbi.nlm.nih.gov/40509705/
Effective Therapeutic Strategies to Prevent Frailty and Falls in Community-Dwelling Older Adults
https://pubmed.ncbi.nlm.nih.gov/40540724/
Gut microbiota has the potential to improve health of menopausal women by regulating estrogen
https://pubmed.ncbi.nlm.nih.gov/40551890/
Twenty Years of Continuous Bisphosphonate Use Leading to Atypical Bilateral Femoral Fractures: A Case Report
https://pubmed.ncbi.nlm.nih.gov/40524410/
Summary of AHRQ’s comparative effectiveness review of treatment to prevent fractures in men and women with low bone density or osteoporosis: update of the 2007 report
https://pubmed.ncbi.nlm.nih.gov/22716221/
Pharmacologic Treatment of Primary Osteoporosis or Low Bone Mass to Prevent Fractures in Adults: A Living Clinical Guideline From the American College of Physicians (Version 1: Update Alert 1: Surveillance Note 1)
https://pubmed.ncbi.nlm.nih.gov/39899855/
2024 Royal Australian College of General Practitioners and Healthy Bones Australia guideline for osteoporosis management and fracture prevention in postmenopausal women and men over 50 years of age
https://pubmed.ncbi.nlm.nih.gov/40134107/
National guidelines for diagnosis and treatment of osteoporosis in Slovakia
https://pubmed.ncbi.nlm.nih.gov/40319419/
Vitamina D
https://www.issalute.it/index.php/la-salute-dalla-a-alla-z-menu/v/vitamina-d
Vitamina K
https://www.issalute.it/index.php/la-salute-dalla-a-alla-z-menu/v/vitamina-k
Calcio, Minerali e Oligoelementi
https://www.issalute.it/index.php/la-salute-dalla-a-alla-z-menu/m/minerali-e-oligoelementi?highlight=WyJjYWxjaW8iXQ==#macroelementi
Studio Mura is a leading dental practice dedicated to promoting health and prevention.
The CARE and SATISFACTION of our PATIENTS are at the heart of everything we do.
