A new study from Finland has found that certain medications used to treat bone conditions, especially when combined with corticosteroids, may greatly increase the risk of a rare but serious disease that affects the jaw.
The disease, called osteonecrosis of the jaw, involves the breakdown and death of jawbone tissue. While rare, it can lead to painful and severe complications.
Researchers at the University of Oulu looked at health records from nearly 60,000 adult patients in Finland who started using bone-strengthening drugs between 2013 and 2015. Their findings, published in Scientific Reports, are the first large-scale study in Finland to explore how common this condition is and what factors increase the risk.
The study focused on antiresorptive drugs (ARs), which are commonly prescribed to prevent bone loss in people with osteoporosis or to stop the spread of cancer to the bones in patients with breast or prostate cancer. Two common types of AR drugs are denosumab and bisphosphonates.
The researchers found that the risk of jaw osteonecrosis depends heavily on the type of drug and the dose. Among patients using low doses of AR drugs, the condition occurred in about 0.3% of users. But among those on high doses—such as patients being treated for cancer—the risk jumped to 9%. This is a significant increase, considering the serious nature of the condition.
One key finding is that people taking denosumab were five times more likely to develop jaw problems compared to those using bisphosphonates. Denosumab is often used because it is effective at preventing bone loss, but the study suggests that it may carry a higher risk to the jaw.
Another major concern is the impact of corticosteroids—medications commonly used to treat inflammation in conditions like asthma or arthritis. When corticosteroids were used together with bone medications, the risk of jaw osteonecrosis increased dramatically.
For those on high doses of AR drugs, adding corticosteroids doubled their risk. For those on low doses of AR drugs, the risk increased sixfold.
Other risk factors included being male and having a cancer diagnosis. These factors made it more likely that a patient would develop jaw complications while on bone medication.
Miika Kujanpää, a dentist and doctoral researcher at the University of Oulu, said the size of the risk difference between the two drugs was surprising. He also noted that the increased risk from combining corticosteroids with even low doses of AR drugs was unexpected and concerning.
Based on their findings, the researchers recommend that doctors and dentists work closely together to protect patients’ oral health before and during treatment with bone medications.
Patients should have their teeth and gums checked regularly, especially if they are taking denosumab or also using corticosteroids. Catching dental problems early and maintaining good oral hygiene could help lower the chances of developing this jaw condition.
In summary, while medications like denosumab and bisphosphonates are important tools for treating bone conditions, they are not without risks. The study highlights the need for careful monitoring, especially when these drugs are used alongside corticosteroids.
Reviewing each patient’s medication plan and taking steps to protect oral health could make a significant difference in preventing serious complications like osteonecrosis of the jaw.
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The research findings can be found in Scientific Reports.
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