Is it suitable to osteoporosis pt on bisphosphonates (Fosamax) for dental implantation

Because of the potential for developing osteonecrosis of the jaws, oral surgery procedures are contraindicated in these cases. This means no extractions or dental implants. Going off the drug will not make them better candidates for dental implants because the effects of bisphosphonates lasts for years.

Comments by Larry S.

Let me preface my remarks by saying that this is not legal advice. I recently attended the International Associaation of OMFS meeting in Vienna and there was a symposia on management of the osteonecrosis patient on bisphosphonates. Fortunatly, almost all reported cases are due to the use of IV bisphosphonates (the exact number escapes me but I remember it being less than 50 worldwide on Fosamax and over 1500 reported on the IV drugs). The general consensus of that meeting (again NOT legal advise) was the routine dentoalveolar surgery including implant placement in patients on Fosamax was OK, but contraindicated in those on the IV meds. Obviously those on IV meds have significant medical problems including metastatic disease, lymphoma, ect. As an oral sureon, I don't really have much choice about extracting some teeth on patients on Fosamax, but I do have a "talk" first about risks/benefits.To put it in perspective, Fosamax has been used for years in millions of doses and ther are precious few reports of negative side effects. I think you have to discuss the situation in detail with the patient when you are doing elective surgery.