What You Should Know About Dental Surgery and Osteoporosis Medications

Expert Insight from Marielaina Perrone, DDS – Green Valley, Henderson, NV

If you’re one of the millions of Americans managing osteoporosis, chances are you’re taking a medication that helps protect your bones—like Fosamax®, Prolia®, or Tymlos®. While these medications effectively reduce fracture risk, they can also impact how your body responds to dental surgery, including tooth extractions, dental implants, and bone grafting.

To better understand how these medications may affect your dental treatment, we spoke with Dr. Marielaina Perrone, DDS, a trusted cosmetic and general dentist in Henderson, NV, who regularly treats patients with complex medical backgrounds.

“Osteoporosis medications can influence bone healing,” explains Dr. Perrone. “That’s why it’s important for patients to share their full medical history—including any bone medications—with their dental provider.”

Common Osteoporosis Medications That May Impact Dental Care

There are three main categories of osteoporosis medications that dental professionals look out for:

 Bisphosphonates (e.g., Fosamax®, Boniva®, Reclast®)

• Help slow bone loss
• Stay in your bones for years
• This may increase the risk of a condition called osteonecrosis of the jaw (ONJ) after surgery

 Denosumab (Prolia®)

• Slows down bone breakdown
• Wears off faster than bisphosphonates (about 6 months)
• Still linked to ONJ risk if surgery is done too soon after a dose

 Tymlos® (abaloparatide) and Forteo® (teriparatide)

• Help build new bone
• Usually prescribed for those at higher risk of fractures
• Generally lower ONJ risk, but caution is still advised

“Even if a medication promotes bone growth, like Tymlos, it’s still essential we evaluate how it could affect healing after surgery,” says Dr. Perrone.

What Is Osteonecrosis of the Jaw (ONJ)?

Osteonecrosis of the jaw is a rare but serious condition where the jawbone doesn't heal properly after surgery, leading to exposed bone and delayed healing.

Although rare in patients taking osteoporosis meds for non-cancer reasons (like postmenopausal osteoporosis), the risk increases with:

• Length of time on the medication
• IV forms of bisphosphonates
• Invasive procedures (e.g., tooth extractions or implants)
• Additional medications like steroids

What Your Dentist Needs to Know

Before any dental surgery, your dentist should ask questions like:

• What osteoporosis medication are you taking?
• How long have you been on it?
• Is it oral or injectable?
• Are you taking other medications (like corticosteroids)?
• Have you ever had problems with slow healing or jaw pain?

“Patients often forget to mention these medications, but they can dramatically affect how we plan treatment,” Dr. Perrone says. “We always want the safest path forward.”

How Dental Professionals Manage Risk

Based on your medication history and health, your dentist may recommend:

• Delaying surgery if a high-risk medication was recently administered
• Modifying the procedure to reduce trauma
• Speaking with your physician about possibly pausing your medication (called a “drug holiday”)—especially with injectable medications like Prolia®
• Using antibiotics and careful suturing to help reduce infection risk

“We don’t make medication changes without your doctor’s guidance,” Dr. Perrone adds. “But we do work closely with them to coordinate care.”

Can You Still Have Dental Implants or Extractions?

Yes—but with precautions.

For low-risk patients (e.g., those on oral medications for under four years with no other health concerns), procedures can usually proceed with standard planning. For higher-risk patients, dentists may recommend non-surgical alternatives or work with their doctors to adjust timing.

“In most cases, patients can still get the care they need,” says Dr. Perrone. “It’s just about tailoring the approach to minimize risk.”

What You Can Do as a Patient

• Always disclose your full medication list at dental appointments
• Don’t stop taking osteoporosis medications without your doctor’s advice
• Ask questions about the timing of procedures and risks
• Maintain excellent oral hygiene to reduce the need for invasive procedures

“The best thing patients can do is be proactive,” Dr. Perrone concludes. “When we have all the information, we can deliver safe, predictable results—even with complex medical histories.”

About Marielaina Perrone, DDS

Dr. Marielaina Perrone, DDS is a top-rated cosmetic and family dentist in Green Valley, Henderson, NV. She offers personalized care in dental implants, cosmetic dentistry, smile makeovers, and the management of patients with medical complexities. She is passionate about preventive care, patient education, and the connection between oral and systemic health.