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Common Bone Meds Plus Steroids linked to Jaw Disease Risk
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A new study from Finland highlights the elevated risk of osteonecrosis of the jaw when certain bone medications are combined with corticosteroids, prompting calls for closer monitoring.
The use of specific medications for bone conditions, especially alongside corticosteroids, may substantially elevate the risk of a rare but severe jaw disease. This conclusion stems from research conducted at the University of Oulu, which scrutinized data from Finnish adult patients initiating bone medication between 2013 and 2015. The research team advocates for enhanced vigilance and deliberation in the prescription of these medications.
The condition in question is osteonecrosis of the jaw, characterized by the weakening and deterioration of the jawbone as a consequence of medication use. The incidence of osteonecrosis was found to be 0.3% among individuals on low-dose antiresorptive drugs (AR) and as high as 9% among those receiving high doses. Antiresorptive drugs are frequently prescribed in Finland, notably for treating osteoporosis and preventing bone metastases in patients with breast or prostate cancer. Common AR drugs include denosumab and bisphosphonates.
The study indicated that the risk of jaw osteonecrosis was markedly higher in patients using denosumab. These patients were up to five times more likely to experience notable jaw damage compared to those taking bisphosphonates. The concurrent use of corticosteroids further amplified the risk: simultaneous use of corticosteroids along with AR drug increased the risk of developing osteonecrosis of the jaw by 2 times in high-dose AR recipients and 6 times in low-dose AR recipients. Additional risk factors identified include male sex and a cancer diagnosis.
This marks the first population-based study in Finland to investigate the incidence and risk factors associated with medication-related jaw osteonecrosis. The analysis encompassed data from nearly 60,000 Finnish patients.
“Our study confirms that denosumab is associated with a substantially higher risk of jaw osteonecrosis compared to bisphosphonates.”
The researchers suggest that patient treatment plans should undergo more rigorous review when multiple medications are prescribed, particularly denosumab and corticosteroids in combination. They also underscore the importance of oral health care in mitigating risks, emphasizing that the condition of teeth and gums should be evaluated both before and during bone medication treatment.
Frequently Asked Questions
- What is osteonecrosis of the jaw (ONJ)?
- ONJ is a rare condition where the jawbone doesn’t heal properly, often after a minor injury like a tooth extraction. It’s associated with certain medications, particularly those used to treat osteoporosis and cancer.
- Which medications increase the risk of ONJ?
- Bisphosphonates and denosumab, both antiresorptive drugs, are known to increase the risk of ONJ. Corticosteroids, when taken with these drugs, can further elevate the risk.
- What can be done to reduce the risk of ONJ?
- Maintaining good oral hygiene, having regular dental check-ups, and informing your doctor about all medications you are taking can help reduce the risk. Careful review of treatment plans is crucial when multiple medications are in use.
- What are the symptoms of ONJ?
- Symptoms can include jaw pain, swelling, infection, exposed bone in the jaw, and numbness or a heavy feeling in the jaw.
Sources
- Kujanpää, M., et al. (2025).Incidence of medication-related osteonecrosis of the jaw and associated antiresorptive drugs in adult Finnish population. Scientific Reports. doi.org/10.1038/s41598-025-02225-2.
- American Cancer Society
- National Institutes of Health
- Mayo Clinic
- Versus arthritis
- Cancer Research UK
- WebMD
- NHS
- Mayo Clinic
- National Osteoporosis Foundation
- National Institutes of Health
