Timing Tooth Extraction and Elective Orthopedic Surgery While Taking Prolia

July 18, 2015 15 Comments

Several patients have concerns about oral surgery while taking Prolia.  This is not a problem – if you follow guidelines.

Prolia is different from other Antiresorptives.  Prolia does not accumulate in bone.  5 to 6 months after your last dose, Prolia has lost its effect of slowing bone turnover.  Therefore, it is safe to proceed with surgery on bone (including dental surgery) 6 months after your last dose.

Patients worry about OsteoNecrosis of the Jaw (ONJ), but this is very rare.  In fact ONJ virtually never occurs without a tooth extraction or serious periodontal disease.  Even then, it is rare unless you also have cancer,  have poorly controlled diabetes, or are seriously Deficient in Vitamin D3, or Calcium, or Protein intake.

Elective Orthopedic Surgery timing is the same.  If you need a Total Hip Replacement (THR) or Total Knee Replacement (TKR), schedule the surgery for 6 months after your last dose of Prolia.

Any time you plan to have surgery on bone, you should Optimize Your Bone Health First.  Get a Complete Bone Health Evaluation.  Optimize your Vitamin D level (at 40 to 80 ng/ml).  Optimize your Calcium intake in foods and supplements combined (at 400 to 500 mg at all 3 meals daily).  Optimize your daily Protein intake (1 g Protein for every kg body weight).

Sometimes you will also need the Anabolic, Forteo, to increase bone matrix and improve healing.  More about that another time.

Get the best possible result from orthopedic or dental surgery.  Wait 6 months after Prolia, and do your part to optimize your bone health.

Jay Ginther, MD

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  • Carol Collins

    I am scheduled for April 11,2023 for total knee replacement. Nov 22,2022 was last shot. When should I get my next shot? It is due around May 22,2023.

    • Website Creator

      It depends on your healing, but usually, 6 weeks after surgery it is safe to resume Prolia.

  • I took Prolia shot November 2! Due to Chronic Kidney Disease it depleted my electrolytes and I had 2 hospital visits for infusion of cal yams magnesium! My PCP is working on getting these leveled out! My question is, should I have a molar extracted, it’s cracked!

  • Maureen Gill

    I have two autoimmune diseases .Primary Biliary Cholangitis – stage 3-4 ,compensated cirrhosis as well as Sjogrens.I have only had one shot of Prolia – almost 6 months ago. I have developed a dental fistula and need to have the tooth/ teeth removed .
    How long do I wait after surgery to restart Prolia? I am also possibly having two dental implants done on the same side as I will be loosing a large bridge with the extraction.
    Thank you for your reply.

  • Ann

    I left a concern about an extraction. It’s gone now. Did you receive it?

  • Ann

    I received a dose of Prolia six months ago. I now need a tooth extracted. The tooth is loose. I’ve had bone loss at the site since I received the Prolia. (from 4 to 6). The oral surgeon says I need to wait one year since my last (which was my only dose of Prolia) Prolia injection. I believe that the tooth is getting infected. Now what?

  • Cheryl

    I have been taking Tymlos for 15 months now and have been instructed to continue taking it for 9 more months and now I will need to get a tooth pulled. Will I have to stop doing the Tymlos injections ? Is there anything I should be aware of or any concerns any advise would be greatly appreciated

    • Tymlos actually assists healing after a tooth extraction, so there is no need to stop it.
      Of course routine post extraction care, such as antibiotic rinses, is appropriate

  • Donna Friedrich

    My 38 year old daughter is a nurse and has osteoporosis due to past eating issues….. she is currently on prolia and is aware of risks especially concerning tooth extraction…. a couple of dentists agreed that the risks involved regarding necrosis were far less than the infection and pain they had been trying to battle….. therefore, they extracted the tooth…. both dentists have seen her for follow ups and seem to think all is well yet she says still painful and desperately scared something may be wrong at the site and is going back tomorrow….. I feel anxiety and fear may be involved …. I know you can’t diagnose but can you share your thoughts please ?!?!

    • The incidence of ONJ while on Prolia is very low – well less than 1:1000. As soon as the dentist has declared an extraction heale, it should be safe to restart Prolia.
      Incidentally, Forteo has been used at times to treat poor bone in the jaw with success. These reports are in the dental literature. Tymlos is similar and may work as well.

  • Kat Grubb

    I am wondering how long After knee replacement surgery can you take prolia shot. Surgery was Oct 30,17, he wants me to get shot due to dexascan looking bad. April 3. Is that long enough. I am 6yr breast cancer survivor.

    • You can take your next Prolia shot after a tooth extraction or bone surgery as soon as the surgeon or dentist declares the bone to be healed
      Typically this is 6-12 weeks after surgery
      As a breast cancer survivor, Prolia is a great choice, and can help prevent metastaces
      Anabolics, Forteo or Tymlos, are NOT recommended until a person is clear of cancer by 10-20 years

  • Renee

    I had a left knee replacement in Dec 2015. Last Thurs, I got my first Prolia shot. Sat night my bones hurt all over and I was nauseous. Sun, I was still nauseous and slep until 3 pm. Mon, my right shoulder blace and back had a stabbing pain for most of the day. Today my left knee hurts and is swollen red and hard and hurts to put pressure on it. And yesterday a cat bit me and broke the skin . So infected by cat or Prolia reaction.?

    • That would be an unusual reaction to Prolia
      Definitely contact the office from which you got the shot
      Separate topic – cat bites can be very dangerous and can require antibiotics to prevent severe infection
      Be sure to have it evaluated and tell them it was a cat bite

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