Denosumab-related osteonecrosis of the jaw in a patient with bone metastases of prostate cancer: A case report and literature review

Abstract

Denosumab, a human monoclonal antibody directed against the receptor activator of nuclear factor-κβ ligand (RANKL), is used for the treatment of patients with metastatic cancer of the bone or osteoporosis. Recent reports have demonstrated that denosumab can induce osteonecrosis of the jaw (ONJ), but reported cases of this are uncommon. The present study reports the case of an 86-year-old male with prostate cancer patient exhibiting bone metastases who developed ONJ whilst receiving denosumab. To elucidate the influence of denosumab on the development of ONJ, the present study also reviewed the literature, including clinical trials and case reports. In the clinical trials, the prevalence of denosumab-related ONJ was higher in patients with cancer compared with those with osteoporosis. The high risk of ONJ in patients with cancer was thought to be associated with the differing dose and frequency of denosumab administration. The prevalence of ONJ was not significantly different between patients receiving denosumab and bisphoshonate (BP). In the reported cases, denosumab-related ONJ had a similar clinical presentation to BP-related ONJ. There was also a tendency for denosumab-related ONJ to develop in the mandible of elderly patients. Previous invasive dental treatment was a commonly shared characteristic of patients with denosumab-related ONJ. A complex medical history was also suspected to affect the prevalence. No clear association between the dose or duration of denosumab treatment and the development of ONJ was observed. Although conservative treatments are given for denosumab-related ONJ, non-improving cases were managed surgically with primarily positive results. Because denosumab may offer superior results compared with BP for the treatment of metastatic cancer of the bone or osteoporosis, the use of denosumab is expected to increase in the near future. Clinicians should also be aware of the risk factors for denosumab-related ONJ, in order to aid in its diagnosis. In addition, patients treated with denosumab should receive prophylactic treatment to maintain their oral health prior to, during and after denosumab treatment.

Fermented Oyster Extract Prevents Ovariectomy-Induced Bone Loss and Suppresses Osteoclastogenesis

“…Various antiresorptive drugs including bisphosphonates, denosumab, and calcitonin are available for the treatment of osteoporosis via their ability to protect against osteoclastic resorption and preserve bone mass [8]. Although these pharmacological treatments have positive effects on skeletal health, concerns regarding side effects such as osteonecrosis of the jaw in bisphosphonate and denosumab and an increased risk of liver cancer in calcitonin have emerged, which have led to increased interest in the discovery of alternative agents capable of suppressing osteoclastogenesis [9,10,11].…”

Molecular-Based Treatment Strategies for Osteoporosis: A Literature Review

“…Several significant and serious adverse events, including hypocalcemia, osteonecrosis of the jaw, and atypical femoral fracture have been reported in the literature, and these incidences do not differ between denosumab and BPs [53,54,116,117,118]. The FREEDOM extension study evaluated the effect of 3 or 6 years of denosumab treatment; 6 out of 4550 participants experienced events of osteonecrosis of the jaw, whereas one participant developed an atypical femoral fracture.…”

The Biological Enhancement of Spinal Fusion for Spinal Degenerative Disease

“…Significant and serious side effects of denosumab include hypocalcemia, osteonecrosis of the jaw and atypical femoral fracture, these side effects being similar to those of bisphosphonate [ 48 , 49 , 50 ]. Zhou et al [ 51 ] reported that denosumab significantly reduced the risk for fractures except for vertebral fractures.…”