Certain medications used in the treatment of bone conditions, particularly when combined with corticosteroids, may significantly increase the risk of a rare but serious jaw disease. This finding comes from a study by the University of Oulu, which analysed data from Finnish adult patients who began bone medication between 2013 and 2015. The researchers recommend more careful monitoring and consideration in the use of such medications.

The condition in question is so-called osteonecrosis of the jaw, in which the jawbone weakens and deteriorates as a result of the medication. The incidence of osteonecrosis was 0.3% among low-dose antiresorptive drug (AR) users and as high as 9% among those receiving high doses. Antiresorptive drugs are commonly used in Finland, particularly in the treatment of osteoporosis and in the prevention of bone metastases in patients with breast or prostate cancer. The most commonly used AR drugs are denosumab and bisphosphonates.

According to the study, the risk of jaw osteonecrosis was significantly higher in patients using denosumab. These users were up to five times more likely to suffer serious jaw damage than those taking bisphosphonates. When corticosteroids were also involved, the risk increased further: simultaneous use of corticosteroids in addition to AR drug increased the risk of developing osteonecrosis of the jaw by 2 times in high-dose AR recipients and 6 times in low-dose AR recipients. Other significant risk factors for jaw osteonecrosis included male sex and a cancer diagnosis.

This is the first population-level study conducted in Finland on the incidence and risk factors of medication-related jaw osteonecrosis. The analysis covered data from nearly 60,000 Finnish patients.

“Our study confirms that denosumab is associated with a significantly higher risk of jaw osteonecrosis compared to bisphosphonates, but the difference in risk between the two was surprisingly large. It was also particularly surprising how strongly the simultaneous use of corticosteroids increased the risk in patients on low-dose bone medication,” says Miika Kujanpää, doctoral researcher at the University of Oulu and dentist.

The researchers recommend that patient treatment plans be reviewed more carefully when multiple medications are in use, particularly denosumab and corticosteroids together. They also emphasise the role of oral health care in reducing risks – for example, the condition of teeth and gums should be checked both before and during bone medication treatment.