Dental Extraction in Patients on Reclast (Zoledronic Acid) with Osteoporosis

Pre-Treatment Requirements

The American College of Oncology recommends that all patients undergo an oral examination and complete any necessary preventive dentistry before starting bisphosphonate therapy, to reduce the risk of medication-related osteonecrosis of the jaw (MRONJ) 1, 2, 3
Pre-treatment dental clearance is critical because the risk of MRONJ increases with invasive dental procedures performed during active therapy, with an incidence of 0% to 0.5% with oral bisphosphonates and 0% to 1% with IV bisphosphonates given every 6-12 months 4

The American College of Oncology recommends suspending Reclast administration until the tooth socket appears completely healed, to minimize the risk of MRONJ 1, 2, 3, 7
Prophylactic antibiotics should be administered at the time of extraction, to prevent infection and promote healing 1, 2, 3, 7

The risk profile for MRONJ with osteoporosis-dose bisphosphonates is substantially lower than with cancer-dose regimens, with an absolute risk of 0-1% 4
The American College of Clinical Oncology notes that this lower risk must be weighed against the significant benefit of fracture reduction that bisphosphonates provide 4, 6

The American College of Oncology recommends that denosumab should not be interrupted due to the risk of rapid rebound bone turnover and vertebral fractures upon discontinuation 1, 3, 7

The American College of Oncology recommends never performing invasive dental procedures without proper wound closure and antibiotic prophylaxis in patients on any bone-modifying agent 1, 2, 3
Reclast should not be resumed before complete mucosal healing of the extraction site, to minimize the risk of MRONJ 1, 2, 3, 7

The American College of Oncology recommends ensuring adequate calcium (1000-1200 mg/day) and vitamin D supplementation throughout Reclast therapy, and monitoring serum calcium levels, particularly in patients with renal impairment 8