Q. Can you please give me more information on the connection between Boniva and osteonecrosis of the jaw? I heard about this on the radio.

I have taken Fosamax and Actonel for osteoporosis but had to discontinue because of digestive problems. Now my doctor is insisting that I try Boniva.

I am skeptical of these drugs, but find that doctors dismiss the dangers of side effects until the damage is done. I want to arm myself with more information about these drugs for my next doctor’s visit.

A. A new study in the Journal of the American Dental Association (Jan. 2009) suggests that jaw bone death (osteonecrosis of the jaw) may be triggered by drugs such as Actonel, Boniva and Fosamax. In this investigation, up to 4 percent of Fosamax patients having a tooth extraction experienced this serious complication.

We are sending you our new Guide to Osteoporosis with an in-depth discussion of the pros and cons of all the drugs used to treat this condition. Other side effects of such drugs have recently come to light in The New England Journal of Medicine. They include unusual thigh-bone fractures (March 20, 2008) and a possible increased risk of esophageal cancer (Jan. 1, 2009).

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  1. Sue

    I’ve been on Actonel for 6 months,and my 2 front teeth moved apart and now I have a space. My gums and top teeth hurt and feel a little loose. If I stop Actonel will my bones get stronger?

  2. JC

    Don’t know that this will get to you or not since this blog is not that recent, but I too am 63 years old. I started taking Actonel when I was 53 (had gone through menopause) for 5 years at the suggestion of my doctor because of having a bone density test indicating osteopenia in my left hip.
    During my 4th year on Actonel, I had to have 2 teeth extracted because they were loose. Nobody knew why this happened. Had to have 2 dental implants placed. Now at age 63, I am currently being treated to have my 10th (that’s right, TENTH) dental implant. Each time I lost a tooth, I also had to have a bone graft because my jaw bone had lost density and dentist now says it’s because of that medication.
    THERE SHOULD BE SOME COMPENSATION FOR THIS, as I’ve put over $30,000 into my mouth due to jaw deterioration, loss of teeth, dental implants, and crowns.

  3. S. Small

    I’ve been on Boniva for 6 years +/- for osteoporosis. I now have a non repairable cracked tooth in my upper jaw… My family doctor seems to think it is no problem… My dentist disagrees because he has had a case of dead jaw bone… And he has a relatively small practice.. The local oral surgeon has also had a case.. Both involving fosomax or boniva.. I canceled the extraction appointment today and hope to stay off Boniva for as long as possible before having the extraction.. ANY ADVICE ????? THANKS, SS

  4. JC

    Well all, let me tell YOU! I was on Actonel for 5 years because of having developed osteopenia in my left hip. (I’m no longer on Actonel)
    The beginning of all of my dental problems started at the 4-year mark. My first tooth that broke off was my first dental implant. When the dentist x-rayed and then got into my jaw bone, he said my jaw bone needed a bone graft prior to inserting an implant.
    Now after much dental work and now after $30,000 implants/crowns, I have started the procedure for my 10th (that’s right…TENTH) dental implant. All of my teeth that needed replaced with an implant required substantial bone grafts.
    All of my life I took very good care of my teeth (brushing/flossing/regular cleanings and check-ups). I know that because of taking Actonel for 5 years, this is why my jaw bones had deteriorated because there could be no other reason! I can’t tell you how upset I am about this. Where’s the justice in this!?

  5. sep

    I am 61 and have been on fosamax, actonel, Evista and Boniva. Total for 12 yrs. I have not experienced any problems. Now I have to have a tooth extracted and panicking. I am off those drugs now, I cannot take the worry about dead jaw. Does anyone one know the how great the chances are for dead jaw and being on it for 12 yrs. Are there many on this forum experiencing this jaw problem as a result of extraction?. Thanks

  6. bkp

    I am 63 and had been on Actonel for several years until I read about it’s potential for bone loss. I got off of it in June 2011. I was plagued by 2 loose lower jaw teeth. My oral surgeon suggested we pull the remaining 7 lower teeth, put in implants and attach a lower denture. When he looked at the x-rays, he thought I had good solid bone in the front of my jaw.
    Sadly, infection set in and 2 of the implants had to be removed. He is blaming it on Actonel. But, I wonder if he could not have seen the bone damage when he opened the gums to remove the teeth? Is it not a visible condition? Also, I saw an article linking Protein Pump Inhibitors to jawbone loss. Any research on that? Thanks.

  7. Mary L.

    I took actenol for 3 1/2 yrs…. had to have a tooth pulled in Jan of 2009 and I went off actenol in Aug of 2008….. seems things are fine.. have to have a tooth pulled tomorrow after a having a root canal to try to save the tooth and prevent extraction.
    I also have had a lot of prednesone over the yrs for breathing problems……
    I am obsessed with bone death and am very worried about this tooth and many others that are left……
    Do you have any new info on actenol use and the risk of bone death… numbers of cases and numbers of death to the person?
    thank you

  8. Jean

    I am a 56 year old woman and have just been told I have osteoporosis. My Dr. would like me to start on Boniva, however I do occasionally have problems swallowing. I am nervous about the problems that have been reported and am wondering about the effectiveness of the medication, and if there is anything natural that I can do which would be as effective.

  9. Rose

    I am 57 year old white 130 pound female. I’ve never had children. I started menopause last year at 56. At that time I had a bone density test and was told I was borderline osteopenia. Recently I had an x-ray of my shoulder and the othopedic surgeon said he could see that I have osteoporosis on the xray.
    I asked my GP what he thought about that and he recommended I start taking a prescription of Actonel weekly. I have heard all the stories about Actonel causing all types of other problems including bone deterioration in the jaw. I just do not want to take drugs of any type. I would prefer to exercise and take calcium supplements. Would that be enough or do I really need to take Actonel to stop bone loss?

  10. Ann O.

    My oncologist put me on Fosamax but my Doctor suggested the once a year Reclast IV. I have been trying to get info on which one is more likely to cause jawbone death. I know the Fosamax is causing some upper GI problems already, and now I am hearing it may be the cause of fractures which I thought it was supposed to prevent! Duh!

  11. R.H.

    My sisters femur broke in 2006 in her left leg and now her right femur has a stress fracture starting. She has been on Fosamax since 1996 and her doctor told her to stop taking it immediately when the newest stress fracture was detected. He indicated that the first femur break could be atttributed to Fosamax.
    Please let me know where I can find out if there are more people suffering the same effects and what can be done to prevent further bone deterioration. I am taking Boniva and have had jaw pains for almost two years on and off. I have been X-rayed and talked to several physicians to no avail.
    Thank you for any help you can give. Rose H.

  12. VRD

    I am 50 and have been on Boniva for five years without any jaw bone problems or any other side effects.

  13. Connie F.

    I have been on Fosamax 70mg. for about three years. Lately, I have experienced severe constipation and quite a bit of jaw pain, which I thought was associated with involved dental surgery that required cutting into the bone. I am leery about the Fosamax now because my jaw should be healed up. Could the Fosamax be causing this chronic pain?

  14. PF

    My 81 year old has fairly severe osteoporosis and has been on actonel for a few years. After being on it for a couple of years she starting losing many teeth at an unnatural rate, and had bone fragments sticking through the gum. She has since suffered with heart ailments which include arrhythmia. I find actonel the likely contributor or suspect, but since it isn’t a controlled environment it is hard to be conclusive.

  15. jacki

    i was on evista, fosamex & for 2 years on forteo injections which i had to give myself daily. i had heartburn a lot & finally , on my own (md didn’t recommend it) I went to a GI md & took an endoscopy & was diagnosed with barretts esophogus. i also had many dental implants & although I don’t have bone loss in my jaw bone itself, i do have extreme resession that i believe is from all these meds. i am now trying once a year reclast & hope this doesn’t cause problems too.

  16. wz

    I have very strong bones but am aware some women do not and I was wondering if putting stress on bones and eating a healthy diet would be just as good as taking these drugs? I’ve heard Evista helps? Didn’t the former Governor of Texas, Ann Richards take Evista?

  17. Anna B.

    I’ve been on bisphosphonates for a very long time with no apparent problems. I started on Fosamax when it was taken every day and had a 40 minute wait before eating. I tried miacalcin for a while, but the bone scan results were not as favorable. I’ve been taking Actonel for about 7 years. Last winter I had three teeth extracted after going off the Actonel for three months as recommended by the oral surgeon. So far, so good with respect to the jaw. What they really, most emphatically warn against is implants. Extraction is trauma enough without putting a half inch screw into the jaw bone!

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