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Osteoporosis (from "osteo," meaning bone, and "porous," meaning sieve - or sponge-like) is a condition in which the bones lose calcium, becoming thinner and more prone to fracture. An ongoing process called bone remodeling, in which old areas of damaged bone are removed ("resorbed") and replaced with new structurally-intact bone, is normal for adults. Under ideal circumstances, these two processes - bone resorption and bone formation - are balanced. Living bones are not like the dry bones of skeletons you see in a museum, which are static and unchanging. Many things can change the balance between normal bone resorption and formation. In osteoporosis, the balance is tipped toward resorption, so more bone is removed than is replaced, resulting in a gradual decrease in the bone density over the years. In recent years, oral (taken by mouth) drugs in a class known as bisphosphonates have been widely used to treat osteoporosis. They act by slowing the excessive bone resorption, establishing a better balance between resorption and formation and increasing bone density.



But we've noticed something different in the bone of the jaws. In rare cases, a long-term user of a bisphosphonate drug may develop a complication called osteonecrosis ("osteo," - bone, "necrosis," - death), in which isolated areas of the jaw bone lose their vitality and die. For such an individual, tooth removal or any kind of oral surgery involving the jaw bone must be carried out with care. Expert opinion recommends that bisphosphonate treatment be stopped for three months or more prior to surgery, if possible.

The cause of osteonecrosis is not well understood, but it appears that the people at greatest risk are those with underlying cancers who have received relatively high-dose, intravenous ("intra," - within, "venous" - vein) bisphosphonate treatment, typically given every month over an extended time. The risk of osteonecrosis with relatively low-dose, oral treatment - as is used for the prevention and treatment of osteoporosis - has not been firmly established, but appears to be much smaller.

Osteoporosis (from "osteo," meaning bone, and \"porous,\" meaning sieve - or sponge-like) is a condition in which the bones lose calcium, becoming thinner and more prone to fracture. An ongoing process called bone remodeling, in which old areas of damaged bone are removed ("resorbed") and replaced with new structurally-intact bone, is normal for adults. Under ideal circumstances, these two processes - bone resorption and bone formation - are balanced. Living bones are not like the dry bones of skeletons you see in a museum, which are static and unchanging. Many things can change the balance between normal bone resorption and formation. In osteoporosis, the balance is tipped toward resorption, so more bone is removed than is replaced, resulting in a gradual decrease in the bone density over the years. In recent years, oral (taken by mouth) drugs in a class known as bisphosphonates have been widely used to treat osteoporosis. They act by slowing the excessive bone resorption, establishing a better balance between resorption and formation and increasing bone density.

But we've noticed something different in the bone of the jaws. In rare cases, a long-term user of a bisphosphonate drug may develop a complication called osteonecrosis ("osteo," - bone, "necrosis," - death), in which isolated areas of the jaw bone lose their vitality and die. For such an individual, tooth removal or any kind of oral surgery involving the jaw bone must be carried out with care. Expert opinion recommends that bisphosphonate treatment be stopped for three months or more prior to surgery, if possible.

The cause of osteonecrosis is not well understood, but it appears that the people at greatest risk are those with underlying cancers who have received relatively high-dose, intravenous ("intra," - within, "venous" - vein) bisphosphonate treatment, typically given every month over an extended time. The risk of osteonecrosis with relatively low-dose, oral treatment - as is used for the prevention and treatment of osteoporosis - has not been firmly established, but appears to be much smaller.