Rare Isn’t the Same as Never: What I’ve Seen with Bone Medication

Posted on: September 8th, 2026 by SmartLife Medicine

The first thing I learned in medical school, over two decades ago, has stuck with me more than almost anything else: “First, do no harm.” It’s the principle that the treatment itself should never carry more risk than the condition it’s meant to address. Every treatment decision — whether it’s a medication, a procedure, or doing nothing at all — deserves that same weighing of risks and benefits.

Osteonecrosis of the Jaw: Rare Isn’t the Same as Never

A patient I’ve been seeing for a shoulder injury reminded me of this recently. She’s active, health-conscious, and proactive — the kind of patient who stays on top of her care. She’s also been receiving regular infusions of a bisphosphonate medication for osteoporosis. Last week, she was diagnosed with osteonecrosis of the jaw — a known but uncommon complication of that medication class, one that can affect the ability to eat comfortably and requires its own difficult treatment.

This isn’t the first time I’ve seen a patient harmed by the very treatment meant to protect her bones. I’ve also treated patients with bisphosphonate-related femoral fractures. These complications are documented on the medication’s own label and are considered rare — but rare isn’t the same as never, and for the patient living through it, the statistic doesn’t matter much.

The Conversation That Doesn’t Happen

I want to be clear about something: these medications help many people, and for many patients, the benefits outweigh the risks. That’s a conversation between a patient and their physician. What concerns me is how often that conversation doesn’t happen — how often a patient is handed a prescription based on a single number, without a fuller picture of their actual bone health or a real discussion of alternatives.

Two Scores That Hadn’t Gotten Worse

I saw this again with two other patients recently. Both had been told to start medication based on their DEXA T-scores. Neither patient’s score had gotten worse — one was unchanged, one had actually improved. When we performed an Echolight REMS scan, which measures bone strength and quality in addition to density, one patient’s results were reassuring enough that no medication was needed at all. She’ll return to load-bearing exercise and we’ll recheck in a year.

Why We Started OsteoSmart

This is the heart of why we started OsteoSmart. First, do no harm. Second, get a fuller picture before making a decision that can’t be undone. Whether that means feeling confident stepping into a load-bearing exercise program without fear, or exploring a non-pharmaceutical path — patients deserve to make that choice with complete information, not just a single number and a prescription pad.

Thank you for reading. We’re here to be partners in that decision — not to make it for you.

Best,
Matthew Vogt, MD

Call (331) 244-1102 to book a scan or ask us a question.

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Reference

U.S. National Library of Medicine, DailyMed. “FOSAMAX (alendronate sodium) tablet — Prescribing Information.” Osteonecrosis of the jaw and atypical femoral fractures appear in Warnings and Precautions, Sections 5.4 and 5.5.
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=14e931fd-2c5f-4d90-b7db-5980706f4a56

This post is for educational purposes only and does not constitute medical advice. Always consult your physician before making changes to your care.