New research reveals that common bone medications—especially when paired with corticosteroids—may dramatically raise the risk of a rare and damaging jaw disease.
A new study from the University of Oulu is raising important questions about the safety of certain bone treatments. Researchers have discovered that some medications used for bone health, especially when taken alongside corticosteroids, may sharply increase the risk of developing a rare but serious condition known as jaw osteonecrosis.
This condition causes the jawbone to weaken and break down over time. The research, which looked at data from tens of thousands of Finnish adults who began bone treatment between 2013 and 2015, suggests the need for more careful patient monitoring and treatment planning.
So what’s behind this risk? The study focused on antiresorptive drugs, which are commonly prescribed to treat osteoporosis and to prevent bone complications in people with breast or prostate cancer. These drugs help slow bone loss, but in some cases, they may do more harm than good. The most widely used medications in this category are denosumab and bisphosphonates.
The risk of jaw osteonecrosis wasn’t the same for everyone. It appeared in just 0.3 percent of patients using low doses of antiresorptive drugs. But among those on high doses, the rate jumped to 9 percent.
Denosumab and Corticosteroids: A Risky Combination
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 emphasize 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.
Reference: “Incidence of medication-related osteonecrosis of the jaw and associated antiresorptive drugs in adult Finnish population” by Miika Kujanpää, Ville Vuollo, Antti Tiisanoja, Marja-Liisa Laitala, György K. Sándor and Saujanya Karki, 19 May 2025, Scientific Reports.
DOI: 10.1038/s41598-025-02225-2
The study was funded in part by the Finnish Dental Society Apollonia.
Never miss a breakthrough: Join the SciTechDaily newsletter.
Follow us on Google and Google News.