Denosumab osteonecrosis of the mandible: A new entity?A case report

Pichardo, Sarina E.C.; Kuypers, Sophie C.C.; Merkesteyn, J.P.R. van

doi:10.1016/j.jcms.2012.10.014

Cited by 39 publications

(35 citation statements)

References 21 publications

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“…Such lesion was initially termed bisphosphonate-related osteonecrosis of the jaw (BRONJ) as it usually followed the administration of different types of bisphosphonates (BPs). Subsequently, with the advent of new classes of antiresorptive or antiangiogenic medications, such as denosumab, sunitinib, bevacizumab, and ipilimumab, giving rise to similar complications [2–4], the American Association of Oral and Maxillofacial Surgeons (AAOMS) in 2014 recommended the change in the nomenclature into medication-related osteonecrosis of the jaw (MRONJ) [5]. …”

Section: Introductionmentioning

confidence: 99%

Medication-Related Osteonecrosis of the Jaws: Considerations on a New Antiresorptive Therapy (Denosumab) and Treatment Outcome after a 13-Year Experience

Favia

Tempesta

Limongelli

et al. 2016

International Journal of Dentistry

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Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication in patients receiving antiresorptive therapies for bone neoplastic localizations and osteoporosis. The aim of this study was to evaluate the clinicopathological features of MRONJ in a cohort of patients treated by new antiresorptive drugs (denosumab) and the corresponding outcome after 13-year maximum follow-up. Overall, 244 patients affected by MRONJ were treated from 2003 to 2015. After clinical and radiological examinations, all lesions were staged according to a dimensional staging system and then surgically treated. All the denosumab-related lesions were classified as stage II or III, thus requiring a more or less invasive surgical approach, despite the results of many recent studies, which suggested a conservative medical approach with early resolution for MRONJ in patients on denosumab. In the current series, 86.9% of treated lesions showed complete clinical and radiological healing, while 13.1% recurred; all recurrences were detected in patients who could not interrupt chemotherapy, steroids, and/or antiresorptive drugs administration due to their general conditions. In conclusion, all oral specialists should be aware of the MRONJ risk among patients taking new antiresorptive drugs; moreover, our protocol based on surgical treatment guided by dimensional staging could be considered effective in view of the low recurrence rate.

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Section: Introductionmentioning

confidence: 99%

Medication-Related Osteonecrosis of the Jaws: Considerations on a New Antiresorptive Therapy (Denosumab) and Treatment Outcome after a 13-Year Experience

Favia

Tempesta

Limongelli

et al. 2016

International Journal of Dentistry

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“…In the reviewed literature, the most used treatment is the same protocol for BRONJ, which consists of surgery in order to remove the necrotic bone combined with a long-term antibiotic therapy (22,23).…”

Section: Discussionmentioning

confidence: 99%

Surgery Combined with LPRF in Denosumab Osteonecrosis of the Jaw: Case Report

et al. 2016

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This paper describes two cases in which the use of leucocyte-rich and platelet-rich fibrin (LPRF) combined with bone resection did not result in complete tissue response in the treatment of medication-related osteonecrosis of the jaw (MRONJ). It has been recently described in patients receiving subcutaneous administration of RANK-inhibitors, such as Denosumab, and anti-angiogenic drugs, such as Bevacizumab, as observed in our cases. Due to promising results in recent studies, more patients will receive these medications in order to avoid skeletal complications due to metastatic bone disease and, therefore, this scenario has a potential to become a comparable challenge to the bisphosphonateinduced jaw necrosis in the area of Oral and Maxillofacial Surgery. No convincing surgical technique has been described to overcome the non-healing mucosal lesions with exposed bone due to RANK-inhibitor therapy. Based on the findings in the literature and in both cases described herein can be concluded that the use of LPRF should be considered in the treatment of patients with DRONJ. S u r g e r y C o m b i n e d w i t h L P R F i n D e n o s u m a b O s t e o n e c r o s i s o f t h e J a w : C a s e R e p o r t

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“…With the advent of new classes of medication such as denosumab, sunitinib, bevacizumab and ipilimumab (recently described in a separate report) giving rise to a similar complication (Estilo et al, 2008a; Aghaloo et al, 2010; Fleissig et al, 2012; Otto et al, 2013; Pichardo et al, 2013; O'Halloran et al, 2014; Owosho et al, 2015), the condition is now more accurately named medication-related osteonecrosis of the jaw (MRONJ), reflecting the fact that it can be caused by various medication classes (Ruggiero et al, 2014). The AAOMS 2014 position paper describes MRONJ as an area of exposed bone or probed bone either intraorally or extraorally through a fistula of greater than 8 weeks duration in a patient with a history of antiresorptive medications and no history of radiation or metastatic tumor of the jaw (Ruggiero et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…Cases of ONJ related to denosumab use were reported during randomized clinical trials for the treatment of patients with metastatic bone disease; the latter were case reports (Saad et al, 2012; Stopeck et al, 2015; Diz et al, 2012; Pichardo et al, 2013; Malan et al, 2012; Ohga et al, 2015; You et al, 2015; Olate et al, 2014; Qi et al, 2014; Fizazi et al, 2011; Fizazi et al, 2009; Henry et al, 2011; Lipton et al, 2007; Stopeck et al, 2010). In this study we describe a series of 13 cases of osteonecrosis of the jaw in patients treated with denosumab alone.…”

Section: Introductionmentioning

confidence: 99%

Osteonecrosis of the jaw in patients treated with denosumab for metastatic tumors to the bone: A series of thirteen patients

Owosho

Blanchard

Levi

et al. 2016

Journal of Cranio-Maxillofacial Surgery

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This case series describes the course of osteonecrosis of the jaw (ONJ) in thirteen patients with metastatic bone tumors treated solely with denosumab. Patients on denosumab may be more prone to developing ONJ even without a risk/precipitating factor and they may develop ONJ early in their denosumab therapy. The outcomes of ONJ in ten patients following a period of denosumab discontinuation after the onset of ONJ were: 3 had complete resolution of symptoms, 4 patients’ ONJ progressed, 2 patients’ ONJ was unchanged and in 1 patient there was partial ONJ resolution. The role of drug discontinuation prior to an invasive dental procedure or after the onset of ONJ still remains debatable.

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Denosumab osteonecrosis of the mandible: A new entity?A case report

Cited by 39 publications

References 21 publications

Medication-Related Osteonecrosis of the Jaws: Considerations on a New Antiresorptive Therapy (Denosumab) and Treatment Outcome after a 13-Year Experience

Medication-Related Osteonecrosis of the Jaws: Considerations on a New Antiresorptive Therapy (Denosumab) and Treatment Outcome after a 13-Year Experience

Surgery Combined with LPRF in Denosumab Osteonecrosis of the Jaw: Case Report

Osteonecrosis of the jaw in patients treated with denosumab for metastatic tumors to the bone: A series of thirteen patients

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