How do osteoporosis medicines act on the jawbone?
Most osteoporosis medicines slow down bone breakdown and are therefore called antiresorptive drugs. The patient leaflet of the Scottish Dental Clinical Effectiveness Programme (SDCEP) lists bisphosphonates such as alendronic acid, risedronate, ibandronic acid, zoledronic acid and pamidronate, and the antibody denosumab. They lower the risk of fractures but can, very rarely, cause medication-related osteonecrosis of the jaw, abbreviated MRONJ.
Under the 2022 position paper of the American Association of Oral and Maxillofacial Surgeons (AAOMS), MRONJ is present when someone who has received one of these medicines, and has had no radiotherapy or cancer spread to the jaw, has exposed bone in the mouth, or bone that can be probed through a fistula, for more than eight weeks. Which other conditions affect implant planning is summarised in our guide Who can have dental implants?
How high is the risk of osteonecrosis of the jaw?
What matters is less whether the medicine is taken as a tablet or given as an infusion than whether it is used in an osteoporosis dose or in the much higher dose of cancer therapy. The AAOMS gives these estimates in its 2022 position paper:
| Use | Medicine | Risk of osteonecrosis of the jaw |
|---|---|---|
| Osteoporosis | Bisphosphonate tablets | at most 0.05 % (at most 5 in 10,000) |
| Osteoporosis | Zoledronate infusion | at most 0.02 % (at most 2 in 10,000) |
| Osteoporosis | Denosumab | 0.04–0.3 % (0.3 % after ten years) |
| Cancer therapy | Zoledronate | mostly under 5 % (0–18 % in studies) |
| Cancer therapy | Denosumab | 0–6.9 % (under 5 % in most studies) |
| Cancer therapy | Placebo | 0–0.7 % |
The Royal Osteoporosis Society puts the figure for people taking osteoporosis treatments at 1 to 10 in every 10,000. A German S3 guideline on implants under antiresorptive medication (2026) gives about 0.1 percent for primary osteoporosis, about 1 percent for osteoporosis caused by other diseases or treatments, and 1 to about 20 percent for cancer.
After bone-affecting procedures such as an extraction, the risk rises slightly according to the AAOMS. The SDCEP guidance also counts taking a bisphosphonate for more than five years and taking systemic corticosteroids at the same time as factors for higher risk.
Are dental implants possible on osteoporosis medicines?
Yes; taking them for osteoporosis does not in itself rule out implants. The SDCEP guidance does not regard implants as contraindicated in osteoporosis patients, but asks that they be told about the small risk of compromised healing and long-term failure. In the meta-analysis by Stavropoulos and colleagues (2018), implant loss on oral bisphosphonates in osteoporosis doses did not differ from the control group, and the bone around the implants was not compromised.
The German S3 guideline (2026) likewise considers implants possible but requires the individual risk of osteonecrosis to be evaluated before every implant, taking into account the underlying disease, the medicine and how long it has been taken, accompanying cancer or immune therapies, radiotherapy, previous osteonecrosis, wound-healing problems and oral hygiene.
Why is the situation different during cancer therapy?
Because bisphosphonates are given in higher doses and denosumab much more often, the risk rises markedly according to the AAOMS. Its position paper states that implant placement should be avoided in cancer patients receiving antiresorptive drugs by infusion or injection or antiangiogenic (vessel-inhibiting) drugs; the SDCEP guidance likewise says implants should be avoided in patients on high-dose therapy. Other solutions are then discussed, for example dentures.
According to the AAOMS, osteonecrosis around implants usually appears late, more than twelve months on, often at implants placed before the medication began. Anyone who starts such a therapy with implants in place therefore needs regular check-ups.
Does the medicine have to be paused before implant surgery?
There is no uniform recommendation, and the decision always rests with the prescribing doctor. The German S3 guideline (2026) finds no robust evidence for a temporary pause around the procedure and therefore makes no recommendation. The SDCEP guidance also stresses that there is no evidence that stopping a bisphosphonate before dental treatment reduces the risk, because the drug persists in bone for years; the Royal Osteoporosis Society says the same.
With denosumab there is an added concern: according to the AAOMS, stopping it causes a rebound increase in bone resorption that can lead to multiple vertebral fractures. The SDCEP suggests planning non-urgent procedures with the prescriber around the timing of the next injection. It follows that:
- Never change your medicine, dose or injection date yourself.
- Tell your doctor at home about the planned implants.
- If an adjustment is considered, the prescriber and the dental team decide together.
What do guidelines recommend for the procedure itself?
The German S3 guideline (2026) makes specific recommendations for implant treatment under antiresorptive drugs:
- Antibiotic prophylaxis: a perioperative systemic antibiotic prophylaxis should be given (its strongest grade of recommendation).
- Treat infections first: necessary treatment of sources of infection should take place before implant placement.
- Bone augmentation: jaw augmentation should be avoided or reviewed particularly strictly.
- Information: before implant placement, patients should be informed about their individual risk and about the need for structured follow-up.
- Follow-up: patients should be enrolled in risk-adapted follow-up; inflammation around an implant must be treated, because it is usually the trigger of osteonecrosis.
- No blood tests for risk assessment: the bone-turnover marker CTX should not be measured, because its value is not proven.
The SDCEP guidance, by contrast, does not recommend antibiotics specifically to prevent MRONJ, so practice differs between countries; your dentist will explain the approach taken in your case.
What does this mean for treatment in Türkiye?
Coordination with your doctor at home has to happen before you travel. Ask for a short report with the drug name, dose, route, start of treatment, date of the last dose, reason for treatment and accompanying medicines, mentioning the planned implants. Send us this report together with photos and X-rays on WhatsApp for a preliminary assessment. Any change to your medication is decided only by the prescriber and the dental team together, never by you alone and never on the day of treatment.
Expect planning to be more cautious: a bone graft may be avoided. Much of the follow-up that guidelines call for takes place at home; inform your dentist there in advance and hand over your implant card, X-ray copies and treatment summary after your return. If you notice numbness, swelling, pus or exposed bone after returning, a dentist or emergency dental service near you is the first port of call; let us know on WhatsApp as well. More on our page on aftercare and follow-up and in our guide What happens when a dental implant fails?
What information do we need from you?
According to the SDCEP, risk depends on the condition, the medicine, how long it has been taken and the accompanying circumstances. These details make an assessment possible:
- Drug name: as on the packaging or prescription
- Route: tablet, injection under the skin or infusion
- Duration: when treatment started, and medicines taken in the past and since stopped
- Last dose: especially for injections and infusions
- Reason: osteoporosis or cancer therapy
- Accompanying medicines: steroids, chemotherapy, immunotherapy or antibody therapy
- History: earlier non-healing wounds or exposed bone in the mouth
The SDCEP patient leaflet names tingling, numbness, heaviness, pain or a bad taste in the jaw, and swelling, pus, loose teeth or exposed bone as signs to report immediately. General preparation is covered in our guide on preparing for dental implants.
How do we plan implants on osteoporosis medicines at Rönesans?
At the examination in our clinic in Serdivan, we go through all your current and past medicines, their reason and duration, together with your medical history. We check the available bone with a cone-beam CT (CBCT) scan. Our dentists prepare the treatment plan together, and your treating dentist remains the same person. If an adjustment to your medication comes into question, it is coordinated with your prescribing doctor.
Before treatment starts, you receive a written treatment and cost plan; the fee is confirmed after the examination. After implant placement you receive an implant card and copies of your X-rays for your dentist and your prescribing doctor at home. Send documents for a preliminary assessment to +90 532 363 49 54 or call +90 264 606 09 43. The treatment process is described on our dental implants page.