Which osteoporosis therapies carry a risk of osteonecrosis of the jaw?

• A. Calcium carbonate
• B. Vitamin D
• C. Bisphosphonates and Denosumab
• D. Calcitonin

Answer: (C)

Osteonecrosis of the jaw arises when bone turnover in the jaw is suppressed enough to impair healing after dental procedures or infections. The drugs that most commonly cause this are antiresorptives that strongly inhibit osteoclast activity. Bisphosphonates bind to bone and remain in the skeleton for years, continually reducing bone turnover. Denosumab blocks RANKL, preventing osteoclast formation and function. Both therapies have well-documented associations with ONJ, particularly with invasive dental work, poor oral health, or long-term/high-dose use.

Calcium carbonate and vitamin D support bone health but do not suppress osteoclasts in a way that leads to ONJ. Calcitonin reduces bone resorption but is not a common source of ONJ risk in osteoporosis, so it’s not typically implicated. Therefore, the therapies carrying the risk are the antiresorptives: bisphosphonates and denosumab.