This is my post on the other "Oste
openia" thread:
Redwing57 said...
When I started Prolia, I first had to get a "clearance letter" from my dentist. This was to verify I didn't expect any major dental work. The risk of osteonecrosis of the jaw is apparently fairly significant, so they want to minimize the risk as much as possible.
I had no evident side effects from the Prolia, except a good-sized hole in my wallet. It's quite expensive, and the only way I could get it administered was as an outpatient hospital procedure (my onco's office is in a hospital's cancer center). Dumb, because it's just a simple injection. But the shot is so expensive my GP wouldn't even consider administering it because of the insurance hassles. No clinic outside of a hospital setting was willing to do it for me.
Oh, and since my ADT ended and testosterone has recovered we decided eventually to stop Prolia. That's not common either it seems, and no one seems real sure about how one responds to its withdrawal. The dentist still has me on enhanced-fluoride toothpaste to minimize dental risks, just in case.
For what it's worth, Prolia is not a bisphosphonate. From this article
Updating the Management of the Dental Patient at Risk for Osteonecrosis of the Jaw Bone (ONJ) While Taking Bisphosphonates or Denosumab (Prolia®) - Latest Reports from the American Dental Association:
Denosumab (Prolia®) is not a bisphosphonate but a monoclonal antibody which inhibits bone resorption by mechanisms different from those of bisphosphonates.Still, it is an "antiresorptive" therapy, meant to slow the breakdown of bone. (Bone breakdown, or resorption, and formation is a slow but steady process normally kept in balance by the body's systems).
That article is lengthy, and doesn't claim to be presenting a "standard of care". It is to present info that providers are to integrate with their clinical experience. Somewhat frustratingly, it says ONJ due to these kinds of treatments is a very small risk (around 1 in 1000), but some procedures increase risk (like extractions), and no one can predict an individual's risk of ONJ. Oh, and it notes that ONJ can arise spontaneously in people taking these drugs.
Swell. So.... it's a small risk, but dental procedures could make it worse, and we can't tell if you're going to get it as a result. If you do get it, it's not good at all.
I can see why a dentist would be reluctant to do anything. And yet, the article says this:
Implant placement and maintenance: Bisphosphonate treatment is not a contraindication for dental implant placement. Studies to date have shown similar success rates in implant placement in patients with or without bisphosphonate exposure (success 95% or greater). Dentists can inform patients that the risk of developing ONJ as a result of exposure to the bisphosphonates and denosumab is low and that success rates for implants placed in patients receiving bisphosphonate treatment is no different in the short term (less than 10 years) from the success rates for implants placed in patients without a history of bisphosphonate exposure. The executive summary report mentions the lack of data regarding effects of implant placement in patients taking oral bisphosphonates. However, the report also states that the patient may be at increased risk of developing ONJ when extensive implant placement is necessary.In medicine it seems there are very, very few certainties.