Osteoporosis meds carry very low jaw risk across the board. A large study comparing three major classes of antiresorptive drugs — bisphosphonates, denosumab, and SERMs — found no significant differences in the risk of osteonecrosis of the jaw (ONJ). Experts say the fracture-prevention benefits of these medications far outweigh this rare complication for most patients.
Good news for osteoporosis patients and their providers: a new study presented at the ASBMR 2026 Annual Meeting found that the risk of osteonecrosis of the jaw (ONJ) — a serious but rare complication — is similarly low across the three main classes of antiresorptive drugs used to treat osteoporosis: bisphosphonates (BPs), denosumab, and SERMs.
Using a "target trial emulation" design to minimize bias, researchers analyzed data from over 177,000 South Korean adults aged 50+ with osteoporosis. Across all three drug classes, ONJ remained rare, with no statistically significant differences in risk between groups. Experts emphasized that the far greater concern for most patients is the risk of fragility fractures — which antiresorptive drugs can reduce by up to 40%.
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Why it matters: Concerns about ONJ have sometimes led providers and patients to avoid or delay osteoporosis treatment — but this study reinforces that the benefit of fracture prevention strongly outweighs this rare risk for most patients. Clear communication about dental health before starting therapy remains essential.
