Fosamax, a commonly prescribed medication for osteoporosis, has been a pivotal player in the realm of bone health. While it has shown remarkable efficacy in preventing bone fractures, especially in postmenopausal women, concerns have emerged regarding its potential impact on dental health. This article aims to explore the side effects of Fosamax on teeth, shedding light on the intricacies of this widely-used medication.

Understanding Fosamax

Fosamax, also known by its generic name alendronate, belongs to a class of drugs called bisphosphonates. These medications are designed to inhibit bone resorption, making them instrumental in the management of osteoporosis. By enhancing bone density and reducing the risk of fractures, Fosamax has become a cornerstone in the treatment of conditions characterized by weakened bones.

However, as with any medication, Fosamax is not without its share of side effects. One notable concern that has surfaced in recent years is the potential impact on dental health, particularly the jawbone.

Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ)

The most significant dental side effect associated with Fosamax is a condition known as Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ). Osteonecrosis refers to the death of bone tissue, and in the case of BRONJ, it manifests in the jaw. This condition is characterized by the exposure of the jawbone, often accompanied by pain, swelling, and even infection.

The exact mechanism by which bisphosphonates contribute to BRONJ is not fully understood. However, it is believed that these medications may interfere with the normal bone remodeling process, leading to compromised blood supply and increased vulnerability to infections in the jaw.

Prevalence and Risk Factors

It’s crucial to note that BRONJ is a relatively rare side effect of bisphosphonate use, including Fosamax. The incidence is estimated to be less than 1% among individuals taking these medications for osteoporosis. However, the risk increases in patients undergoing higher doses or longer durations of treatment, especially in those receiving intravenous bisphosphonates for cancer-related conditions.

Other risk factors for BRONJ include dental procedures that involve trauma to the jawbone, such as tooth extractions or dental implant placement. Additionally, poor oral hygiene and pre-existing dental conditions may contribute to an elevated risk of developing BRONJ in individuals taking Fosamax.

Clinical Presentation and Diagnosis

The clinical presentation of BRONJ can vary, but common symptoms include persistent pain in the jaw, swelling, and the presence of exposed bone in the oral cavity. Diagnosis often involves a thorough examination by a healthcare professional, including dental and medical histories, imaging studies, and, in some cases, a biopsy of the affected area.

Management and Prevention

Management of BRONJ is challenging, and treatment approaches may include antibiotics to control infection, pain management, and in severe cases, surgical intervention to remove necrotic tissue. Prevention is a key aspect of addressing the potential dental side effects of Fosamax.

Dental professionals play a crucial role in preventing and managing BRONJ in patients taking bisphosphonates. Before initiating bisphosphonate therapy, individuals are advised to undergo a comprehensive dental evaluation to address any existing oral health issues. During treatment, maintaining good oral hygiene practices and regular dental check-ups are essential to minimize the risk of BRONJ.


Fosamax has undoubtedly revolutionized the management of osteoporosis, providing a valuable tool in preventing bone fractures. However, the potential side effects on dental health, particularly the development of BRONJ, warrant careful consideration and monitoring. As research continues to uncover the intricacies of these side effects, healthcare professionals and patients alike must collaborate to strike a balance between the benefits and risks of Fosamax, ensuring optimal bone health without compromising oral well-being.