Dentists and Oral Surgeons are sometimes wary of their patients being on ANY Osteoporosis Medications when they undergo tooth extractions or other dental proceedures. One osteoporosis medication is different from all the others. Forteo is the only Anabolic medication currently available in the USA. Forteo does not cause dental and jaw problems. Forteo can be used to treat ONJ and other bone problems of the jaw.
OsteoNecrosis of the Jaw (ONJ) is a rare complication of tooth extraction. If you have cancer, are on chemotherapy, have uncontrolled diabetes, or are on the higher doses of Antiresorptive Osteoporosis Medications used in Cancer Patients with Metastases, ONJ is less rare.
ONJ is the result of too slow bone repair by the OsteoBlasts (the cells that make new bone matrix). Antiresorptive medications slow down both OsteoClasts (the cells that resorb bone) and OsteoBlasts.
Forteo cannot cause ONJ. Forteo (Teriparatide) stimulates OsteoBlasts. That increases new bone matrix formation. Therefore, Forteo can prevent and treat ONJ.
Forteo has been shown to improve bone healing in dental surgery, including implant osseointegration and healing alveolar defects. Ref: Batshutski JD, Eber RM, Kinney JS, et al. Teriparatide and osseous regeneration in the oral cavity. N Engl J Med. 2010, 363:2396-2405. Ref: Kuchler U, Luvizuto ER, Tangl S, et al. Short-term Teriparatide delivery and osseointegration: a clinical feasibility study. J Dent R. 2011:90(8):1001-1006.
As a former orthopedic surgeon, I have discussed these issues with several of our local oral surgeons and dentists.
If you are facing oral surgery or tooth extraction, discuss your osteoporosis medications with your dental surgeon. Most osteoporosis medications should be held for your surgery. Forteo is the exception. Forteo actually helps your jaw heal after dental surgery.
Jay Ginther, MD