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, according to a study by the University of Oulu, which analysed data from nearly 60 000 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, reports MedicalXPress. The most commonly used are denosumab and bisphosphonates.
According to the study published in Scientific Reports, 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 twofold in high-dose AR recipients and six 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.
“Our study confirms that denosumab is associated with a significantly higher risk of jaw osteonecrosis than 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,” said 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 healthcare in reducing risks – for example, the condition of teeth and gums should be checked both before and during bone medication treatment.
Study details
Incidence of medication-related osteonecrosis of the jaw and associated antiresorptive drugs in adult Finnish population
Miika Kujanpää, Ville Vuollo, Antti Tiisanoja, Marja-Liisa Laitala, György Sándor & Saujanya Karki.
Published in Scientific Reports on 19 May 2025
Abstract
This retrospective study aimed to evaluate the incidence of medication-related osteonecrosis of the jaw (MRONJ) and associated antiresorptive drugs in the Finnish population. All adult patients (aged 18 years and older) who were prescribed with antiresorptive drugs (AR) during 2013–2015 were included in this study. A total of n = 58,367 patients met the inclusion criteria and were followed up until 2020. The outcome variable was the diagnosis of MRONJ during the study period. Patients’ age, gender, type of AR prescribed, reason for using AR drugs, use of corticosteroids, use of vascular endothelial growth factor (VEGF) inhibitors were used as covariates. The incidence of MRONJ was 0.3% in low-dose and 9.0% in high-dose AR recipients in this study population. The risk of developing MRONJ among denosumab users was five times higher in both low-dose and high-dose AR recipients compared to bisphosphonates users. Simultaneous use of corticosteroids in addition to AR drug increased the risk of developing MRONJ by two times in high-dose recipients and six times in low-dose recipients. In conclusion, male, denosumab, any type of cancer diagnosis, high dose of AR drug and simultaneous use of corticosteroids were the most noteworthy risk factors for MRONJ.
MedicalXpress article – Common bone medications linked to serious jaw disease (Open access)
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