These Medications Are Linked to Jaw Disease

• Most participants were older women taking the drugs for osteoporosis, but cancer patients faced higher risks — The average age was 72, and 82% of the participants were women. Most were treated for osteoporosis, but about 13% had a cancer diagnosis. The risk of MRONJ was much higher in those using the drugs to manage cancer-related bone loss, particularly when medications were given in high doses.

• MRONJ rates were five times higher in denosumab users than in bisphosphonate users — Among low-dose users, the risk of MRONJ jumped fivefold when patients were given denosumab rather than bisphosphonates. In high-dose users, that difference held steady, with denosumab triggering the condition at roughly five times the rate of bisphosphonates.

• Corticosteroids made the problem worse, multiplying risk sixfold in some cases — For patients on low doses of antiresorptive drugs, adding corticosteroids increased the risk of jaw disease by more than six times. In those on high doses, the added steroid use still doubled the risk. This combination appears especially dangerous for people using bone drugs preventively, not just for cancer.

• Men, especially those with cancer, had the worst outcomes — Male patients on high-dose therapies were more likely to develop MRONJ than women. The researchers noted this was especially true for men with prostate cancer. Differences in oral hygiene and lifestyle could help explain the gender gap, as men tend to brush less often and have worse dental health overall.

• Biologically, denosumab halts bone repair too aggressively — Denosumab suppresses a key enzyme that signals the presence of osteoclasts — cells your body uses to break down old or damaged bone. By nearly wiping out this enzyme’s activity, denosumab leaves the jawbone unable to heal from minor injuries or infections. This extreme suppression of bone turnover likely explains the rapid onset of MRONJ compared to bisphosphonates, which accumulate slowly in bone over time.

• Drug delivery method also mattered; shots and IVs caused more harm than pills — Intravenous or subcutaneous delivery of antiresorptive drugs resulted in much higher risk than oral dosing. How a drug enters your body changes how aggressively it interferes with bone remodeling.

• Risk jumped dramatically when patients switched from one drug to another — People who were first prescribed bisphosphonates and later given denosumab were more likely to develop MRONJ than those who stayed on a single drug. In low-dose users, this switch more than doubled the risk. The study suggests that stacking these medications is a mistake.

• Cancer patients receiving intravenous treatment were among the highest-risk groups — The paper distinguished between osteoporosis patients and cancer patients, pointing out that cancer patients undergoing IV antiresorptive or antiangiogenic treatment need a complete oral exam before starting therapy. If you’re in this category, you’re at high risk of experiencing complications, especially if you’ve had recent dental work, have poor oral hygiene or use removable dentures.

• More than half of MRONJ cases begin after tooth extraction — According to the findings, 52% to 61% of MRONJ diagnoses were triggered by dental surgeries, especially tooth removals. The paper urged dentists and oncologists to stabilize any dental issues, like infections or advanced gum disease, before a patient ever begins drug therapy.

Even though MRONJ is often triggered by dental procedures like extractions, it also occurs without any dental intervention at all. Your risk increases significantly if you’ve been on antiresorptive drugs for more than two years or have dentures or existing gum disease like periodontitis.⁴

• Your jaw is uniquely vulnerable because of its poor blood supply and constant microbial exposure — Unlike other bones in your body, your jawbone is thin, densely packed and frequently injured through chewing, brushing or dental procedures. The paper explained that reduced blood flow, high bacterial load from the mouth, and ongoing wear and tear create a perfect storm. Once the bone is exposed, it struggles to heal under the effects of bone-suppressing drugs.

• Vitamin D deficiency, local infection and immune suppression all worsen outcomes — Several risk amplifiers were outlined, including low vitamin D levels, chronic inflammation in the mouth and chemotherapy-induced immune dysfunction. These factors interfere with your body’s ability to regenerate bone and fight infections, making it much harder to reverse MRONJ once it sets in.

• Preventive dental care reduces your risk — The paper emphasized that ongoing dental hygiene and regular screenings every four to six months help detect jaw problems before they progress. In later stages, procedures become far more invasive, including partial jawbone removal.

1. Reject bone drugs that shut down natural repair — If you’ve been prescribed bisphosphonates or denosumab, stop and reconsider. These medications create microcracks in your bones by halting the natural breakdown and rebuilding process.⁵ Over time, this makes bones more brittle, not stronger. Denosumab, in particular, drops your osteoclast activity to near zero.

2. Get accurate bone scans without the radiation risk — If you’ve been told to get a DEXA scan to check your bone density, it’s worth taking a step back. DEXA, or dual-energy X-ray absorptiometry, has long been the standard, but it’s far from perfect. These scans deliver inconsistent results and often prompt repeat testing that doesn’t improve outcomes. Notably, the surge in DEXA recommendations coincided with the rollout of pharmaceutical bone drugs, a pattern that raises red flags.

Instead, I recommend a safer and more precise approach: Radiofrequency echographic multispectrometry (REMS) technology. This method analyzes raw ultrasound signals to assess bone strength, giving you a detailed picture of your fracture risk without exposing your body to ionizing radiation.

According to a study in Diagnostics, REMS outperformed DEXA in several ways, making it a smarter option if you’re looking to track bone health or evaluate the effects of lifestyle changes.⁶ It’s a better tool to guide your decisions, especially if you’re trying to avoid unnecessary medications.

3. Rebuild your bones from the inside out with targeted nutrients — Your bones aren’t just calcium — they need a full spectrum of nutrients to grow strong and stay resilient. I recommend optimizing your body’s production of vitamin D and your intake of vitamins K1 and K2, magnesium, calcium, and collagen.

These work together to stimulate healthy bone formation while keeping your mineral balance in check. Collagen is especially important — it makes up the flexible framework that minerals build upon.

4. Train your bones safely with blood flow restriction workouts — If you’re older or can’t lift heavy weights, blood flow restriction (BFR) training is a powerful alternative. It works by briefly limiting blood flow to your limbs during light exercise, triggering a growth response in muscles and bones. You get the benefits of strength training without the strain. BFR has shown promising effects on bone density,⁷ and it’s safe to do even if you’re frail or recovering.

5. Stay consistent with daily movement and mineral-rich food — Your bones respond to your daily habits. Walk every day. Get regular sun exposure to support vitamin D production. If you’ve been on a diet high in linoleic acid (LA), get your sun exposure during early morning or late afternoon — instead of peak hours from 10 a.m. to 4 p.m. — to avoid skin damage.

Eat foods rich in magnesium and calcium, like leafy greens, pastured dairy, and slow-simmered bone broth. Avoid vegetable oils, soft drinks and processed foods, which increase inflammation and disrupt mineral absorption. By focusing on nourishment, movement, and prevention, you give your body the tools it needs to rebuild bone safely, without risking your jaw.