Oral Health›Health conditions and your mouth

Osteoporosis, Bone Medicines and Your Mouth

Osteoporosis can affect the jawbone, and the medicines that protect your bones very rarely cause a jaw problem called osteonecrosis. Here is what to tell your dentist and why you should not stop treatment on your own.

Updated September 2026·By the OHA editorial team·8 min read·How we write
Key takeaways
  • Osteoporosis weakens bones. The American Dental Association says it can affect the jawbone and may lead to loose teeth.
  • Bisphosphonates and denosumab protect against broken bones. Very rarely they are linked to osteonecrosis of the jaw, where an area of jawbone dies. The risk is much lower with osteoporosis doses than with the higher doses used for cancer.
  • Tell your dentist you take a bone medicine, keep your teeth clean and have regular check-ups. If you have dental problems, mention them to your doctor before you start.
  • Do not stop a bone medicine because of dental worries without talking to your doctor. Stopping or delaying denosumab can raise the risk of several spinal fractures.
  • Extractions and implants carry a very small risk of jaw problems on these medicines. Your dentist can talk you through the options.

The NHS describes osteoporosis as a condition that weakens bones, making them fragile and more likely to break, and says it can be treated with bone-strengthening medicines. This guide explains what osteoporosis and its medicines mean for your mouth.

Can osteoporosis affect your jaw and teeth?

The American Dental Association (ADA) says osteoporosis can happen in the jawbone and may lead to teeth becoming loose or falling out. The US Office on Women's Health says gum disease can happen more quickly when bones are weakened by osteoporosis, and that losing bone in the jaw can lead to tooth loss. See loose teeth and gum disease.

The NHS lists risk factors including the menopause, long courses of high-dose steroid tablets, smoking, heavy drinking and having had an eating disorder. See menopause and oral health and eating disorders and your mouth.

Which medicines are used?

  • Bisphosphonates, such as alendronic acid (alendronate), ibandronic acid, risedronate and zoledronic acid, slow the rate at which bone is broken down. They are given as a tablet, a liquid or an injection (NHS). healthdirect Australia says zoledronic acid is a yearly infusion (a drip into a vein).
  • Denosumab also slows bone breakdown. healthdirect says it is an injection that must be given strictly every 6 months to keep working.
  • Romosozumab is another injected medicine (NHS).

The ADA says romosozumab carries the same kind of jaw risk as bisphosphonates and denosumab; some other osteoporosis medicines do not (see the questions below).

What is osteonecrosis of the jaw?

The US National Institute of Dental and Craniofacial Research (NIDCR) says osteonecrosis of the jaw (ONJ) happens when the bone of the jaw dies and may become exposed in the mouth. The NHS explains that the cells in the jawbone die, which can lead to problems with healing. When it is linked to bone medicines, the ADA calls it medication-related osteonecrosis of the jaw (MRONJ).

NIDCR says most cases happen after a dental procedure such as a tooth extraction. The ADA says it can also happen without any dental treatment.

Signs to look out for (NIDCR, ADA):

  • bone showing in the mouth, which NIDCR says lasts more than 8 weeks
  • pain, swelling or infection of the gums or jaw
  • gums that do not heal after an injury or dental treatment
  • loose teeth
  • numbness or a feeling of heaviness in the jaw
  • discharge, including around a dental implant (TGA, Australia's medicines regulator)

NIDCR notes that the bone can start to die without causing pain. It says most people with ONJ who take these medicines for osteoporosis heal with conservative treatment, such as mouth rinses, antibiotics and a guard to cover the area, without surgery.

How likely is it?

It is rare with osteoporosis treatment:

  • The NHS calls it a rare side effect, seen most often with high-dose bisphosphonates given into a vein for cancer. healthdirect says it happens very rarely.
  • The UK Medicines and Healthcare products Regulatory Agency (MHRA) says the risk with osteoporosis treatment is small compared with cancer doses, and higher with more potent medicines such as zoledronic acid and denosumab.
  • The ADA reports an expert panel's highest reliable estimate as about 0.1% (1 in 1,000) of people on osteoporosis doses, and says more than 90% of people diagnosed are having repeated high-dose infusions for cancer.

The ADA lists risk factors including taking these medicines for more than 2 years, gum disease (periodontitis), poor oral hygiene, dentures, smoking, diabetes and being over 65. The MHRA adds dental surgery and poorly fitting dentures. The ADA and the TGA both say the benefits of these medicines outweigh the risks for people with osteoporosis.

Should you see a dentist before you start?

The sources differ on who needs a check-up first.

  • NHS: you may need a check-up before starting a bisphosphonate if you have a history of dental problems. For alendronic acid, check with your doctor or pharmacist first if you have problems with your teeth, are waiting for dental treatment such as an extraction, or smoke.
  • MHRA (UK regulator): everyone with cancer should have a dental check-up before bisphosphonates, but other people only if their teeth are in poor condition. Before denosumab or a bisphosphonate infusion, tell your doctor about any mouth or tooth problems and make sure dentures fit.
  • TGA (Australia): doctors should consider a dental referral before starting, especially for people at higher risk such as older people.
  • ADA (US): it may help anyone starting treatment to see their dentist before or shortly after beginning. Citing 2022 guidance from US oral surgeons, it says dental care can happen at the same time as starting treatment.

What they share: if you have dental problems, loose dentures or a planned extraction, tell your doctor before you start and see your dentist.

While you take a bone medicine

  • Tell your dentist you take it (ADA, NHS). The MHRA says people starting denosumab or a bisphosphonate infusion should be given a patient reminder card about the jaw risk.
  • Keep your teeth clean and have check-ups. For alendronic acid, the NHS suggests a dental check-up every 6 months. The ADA says good oral hygiene and regular dental care may be the best way to lower the risk. See dental check-ups.
  • Keep dentures comfortable. Poorly fitting dentures are a risk factor (MHRA). See dentures.
  • Report problems quickly. The MHRA says to tell your doctor and dentist straight away about loose teeth, pain, swelling, sores that do not heal, or discharge.

Having a tooth out or dental implants

  • The NHS says that with an extraction or implants while taking alendronic acid there is a very small chance of jawbone damage, and your dentist may recommend a different type of treatment.
  • The ADA says people taking these medicines for osteoporosis typically do not need to avoid or postpone dental treatment, and that routine treatment should not be changed just because of them. People on high cancer doses should avoid invasive dental treatment if possible.
  • Implants: the ADA's expert panel says these medicines do not appear to rule out implants, though more research is needed. Leeds Teaching Hospitals NHS Trust lists bisphosphonates among the factors that make late implant failure more likely. See dental implants.

See also having a tooth out and, if you take these medicines for cancer, cancer treatment and your mouth.

Do not stop your medicine on your own

The NHS says that without alendronic acid you are more likely to break a bone, and to speak to a doctor before stopping. The ADA says stopping may not remove the jaw risk and can harm your bone treatment, and that there is not enough evidence to recommend a break from the medicine before dental treatment.

Denosumab needs particular care. The MHRA says an increased risk of several fractures in the spine has been reported within 18 months of stopping or delaying it. It advises not stopping without talking to your doctor, and having a missed injection as soon as possible. See medicines that affect your mouth.

Where to get support

  • UK: the NHS lists the Royal Osteoporosis Society, the national charity, whose helpline is 0300 102 3030 (Monday to Friday).
  • Australia: healthdirect lists the Healthy Bones Australia helpline, 1800 242 141, and Musculoskeletal Health Australia, 1800 263 265.
  • US: the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) lists the Bone Health and Osteoporosis Foundation.
When to see a dentist
  • You are about to start a bone medicine and have tooth or gum problems, loose dentures or a planned extraction. Tell your doctor too.
  • Your gums are bleeding or receding, or a tooth feels loose.
Get help urgently
  • If you take alendronic acid and get a loose tooth, mouth sores, or swelling or pain in your mouth or jaw, the NHS says to call a doctor or NHS 111 straight away and contact your dentist as well, as this could be a sign of jawbone damage. Elsewhere, contact your doctor and dentist promptly (MHRA, ADA).
  • Call 999 or go to A&E (or your local emergency number) if you have a lot of swelling in your mouth or find it hard to breathe, speak, swallow or open your mouth (NHS).

Frequently asked questions

Can I have a tooth out if I take a bisphosphonate?

Usually, but talk to your dentist first. The NHS says there is a very small chance of jawbone damage and your dentist may suggest another option. The ADA says routine treatment should not be changed just because you take these medicines for osteoporosis.

Should I stop my medicine before dental treatment?

No, not without your doctor. The ADA says there is not enough evidence for a break before dental treatment, and the MHRA warns that stopping or delaying denosumab can raise the risk of spinal fractures.

Do all osteoporosis medicines affect the jaw?

No. The ADA links jaw problems to bisphosphonates, denosumab and romosozumab, but not to teriparatide, abaloparatide, raloxifene or calcitonin.

Sources

  1. Osteoporosis, NHS, accessed September 2026
  2. Osteoporosis: treatment, NHS, accessed September 2026
  3. Common questions about alendronic acid, NHS, accessed September 2026
  4. Who can and cannot take alendronic acid, NHS, accessed September 2026
  5. Side effects of alendronic acid, NHS, accessed September 2026
  6. Dental abscess, NHS, accessed September 2026
  7. Dental implants, Leeds Teaching Hospitals NHS Trust, accessed September 2026
  8. Bisphosphonates: osteonecrosis of the jaw, Medicines and Healthcare products Regulatory Agency, accessed September 2026
  9. Denosumab and intravenous bisphosphonates: osteonecrosis of the jaw, further measures to minimise risk, Medicines and Healthcare products Regulatory Agency, accessed September 2026
  10. Denosumab 60mg: increased risk of multiple vertebral fractures after stopping or delaying ongoing treatment, Medicines and Healthcare products Regulatory Agency, accessed September 2026
  11. Osteoporosis medicines, healthdirect Australia, accessed September 2026
  12. Osteoporosis, healthdirect Australia, accessed September 2026
  13. Bisphosphonate drugs and osteonecrosis of the jaw (ONJ), Therapeutic Goods Administration (Australia), accessed September 2026
  14. Osteonecrosis of the jaw, NIH National Institute of Dental and Craniofacial Research, accessed September 2026
  15. Osteoporosis medications and medication-related osteonecrosis of the jaw, American Dental Association, accessed September 2026
  16. Osteoporosis and oral health, American Dental Association (MouthHealthy), accessed September 2026
  17. Common dental concerns for adults 40 to 60, American Dental Association (MouthHealthy), accessed September 2026
  18. Oral health, US Office on Women's Health, accessed September 2026
  19. Osteoporosis: more information, NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases, accessed September 2026

This article is general information about oral health. It is not a diagnosis or a substitute for advice from a dentist or doctor who knows your situation. If you have pain, swelling, bleeding that does not settle, or a problem that is getting worse, see a dental professional. In an emergency, contact your local emergency service.

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