Drug holidays

There is no evidence that MRONJ risk will be reduced if the patient temporarily, or even permanently, stops taking bisphosphonate drugs prior to invasive dental procedures since the drugs may persist in the skeletal tissue for years.

The decision to initiate a drug holiday is the responsibility of the prescribing physician and dental practitioners should not discourage patients from continuing with their medication.

Although not strictly a drug holiday, an acceptable management option for patients with osteoporosis who are being treated with six monthly subcutaneous injections of denosumab is to delay any non-urgent invasive dental treatment in an asymptomatic tooth until the month prior to the patient's next scheduled drug administration. Resumption of denosumab treatment following invasive dental treatment should be delayed until the soft tissues/extraction socket have healed. It will therefore be necessary to closely liaise with the patient's medical practitioner to successfully coordinate this management option.