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Abstract
There have been increasing numbers of reports that anti-osteoporosis drugs cause osteonecrosis.
A typical example is medication-related osteonecrosis of the jaws (MRONJ) which can
cause massive necrosis and defects of the jaws. Thus, the dosage and effects of anti-osteoporosis
drugs should be re-examined. Our hypothesis is that primary moderate osteoporosis
itself is beneficial for bones and should not be excessively treated other than vitamin
D, calcium supplementation and functional exercises. The self-repair and anti-infection
abilities of bone depend on its organic tissues including stem cells, blood vessels,
osteoclastic and osteogenic factors in bone, which jointly fight against invading
pathogens and repair bone damage. Recent evidence supports age-related changes in
mesenchymal stem cell including loss of self-renewal and increases in senescent cell
numbers. Thus, the number of MSCs and vessels need to be increased to achieve functions
similar to those in young people. This requires dissolving a portion of inorganic
materials and providing extra space to hold more cells and blood vessels. In contrast,
anti-osteoporosis drugs prevent bone destruction, and increase mineralization that
occupies the space of organic materials, reduces bone immunity and self-repair. Moreover,
long term use of anti-osteoporosis drugs also have negative effects on long bones
and cartilages. Therefore, moderate age-related osteoporosis is natural in humans
to protect bones. Excessive treatment of osteoporosis weakens immunity and self-repair.