DEAR DR. ROACH: I’m currently in the final stages of recovering from osteonecrosis of the jaw (ONJ). Getting a diagnosis took two months, all of which I spent in excruciating pain. I finally found someone that has knowledge of ONJ. Can this condition recur if I continue taking Prolia? — N.L.

ANSWER: ONJ is a rare side effect of denosumab (Prolia), with one large trial finding the equivalent of about 5 cases per 1,000 people after 10 years. Another trial found that it may be as high as 28 cases.

There’s a very low risk of recurrence of ONJ if you were to restart Prolia. In addition, a person can have rapid bone loss after stopping Prolia, so it’s important to get restarted on treatment when your dental specialist feels that your ONJ is resolved — or at least stabilized and improving. This can help you avoid a fracture.

Most experts would restart denosumab or a bisphosphonate once your ONJ has healed.

DEAR DR. ROACH: I’d love to see a study done on Swedish bitters for the pain of shingles lesions. Dabbing it on with a cotton ball considerably reduces or eliminates the pain. It costs less than $15, and it’s worth using as there currently isn’t any medication for these lesions. I’ve shared this tip with a number of people, who all agreed that it helped. — C.S.

ANSWER: I’m all in favor of more studies on traditional remedies. I couldn’t find any scientific evidence for its use, although I did find many anecdotal reports.

A study would ideally compare the active treatment (bitters is an infusion of multiple botanicals) with something that looked and smelled just like it but contained none of the same ingredients (or nothing known to help). If a person got better with bitters but not the look-alike solution, this would be evidence of its effectiveness.

The pain of a shingles blister (called a vesicle) is due to inflammation of the associated nerve (neuritis). This is different from the complication of postherpetic neuralgia, which usually occurs one to three months after the rash has gone. We do have moderately effective treatments to reduce the pain, but it’s far better not to get shingles at all. This is why I recommend that all adults over 50 (and younger people with immune system diseases) get the shingles vaccine.

DEAR DR. ROACH: My primary care doctor said that I should use Flonase nasal spray for seasonal allergies instead of Allegra because it is more targeted and won’t affect my entire system. However, my eye doctor said that Flonase can cause cataracts or lens clouding because it contains a steroid. This seems contradictory, so which advice is best? I am 79 years old and only take probiotics in addition to Allegra daily. — D.L.L.

ANSWER: Both of your doctors have right information. Flonase works where it’s given — in the nose and sinuses. However, your ophthalmologist is right that because the steroid in Flonase is absorbed to a tiny degree, there’s an increased risk of a cataract.

However, your ophthalmologist could’ve said that the risk is extremely small — approximately 2 additional cases in 10,000 people who use nasal steroids like Flonase, compared to a placebo. These odds are pretty good.

Allegra does affect the entire system, but most people don’t have significant side effects. I personally tell my patients that both Flonase and Allegra are safe and effective over-the-counter treatments, and they can use whichever one they prefer or whichever works better for them. They also work well together for people with more severe symptoms.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc.

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