Risks and complications

Anti-resorptive drug therapy and risk

Anti-resorptive drugs (ARDs) – such as bisphosphonates (BPs) and denosumab – are widely used to treat osteoporosis, because they help reduce pain and spontaneous fractures, and control bone metastases.

“Anti-resorptive drugs (ARDs) are widely used to treat osteoporosis”

There are three groups of ARDs: low dose used in osteoporosis; high dose used in cancer patients with metastases; and a new group of intermediate dose used as ‘adjuvant therapy’ in cancer patients without metastases (to decrease the risk of the cancer recurring).

Potential risks of dead bone and implant loss are related to dose and duration, not to the method by which the drugs are administered.

The most recent data for ARDs come from the EAO Consensus in 2018 (Schliephake et al. 2018). It was concluded that:

“Both low- and high-dose ARD patients are at risk of developing MRONJ”

Some clinical recommendations were also drawn: