Denosumab-related osteonecrosis of the jaw

Dios, Pedro Diz; López-Cedrún, José Luís; Arenaz, Jorge; Scully, Crispian

doi:10.14219/jada.archive.2012.0323

Cited by 72 publications

(49 citation statements)

References 7 publications

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“…These include the potency of the antiresorptive medication, a longer duration leading to an increased cumulative dose, age over 60 years, preexisting oral infection, previous dental treatment, chemotherapy, regular steroid use and smoking. 1,7,12,[18][19][20] Local risk factors include dental extractions, oral, periodontal and periapical surgeries, local anatomical considerations and dental implant placement.…”

Section: Discussionmentioning

confidence: 99%

“…13,16 The first reported case of DONJ was in 2010 8 and since then several similar case reports have been published in the dental and medical literature. 7,19 This included a report from clinical trials undertaken to evaluate denosumab's efficiency and effectiveness. 21 A recent meta-analysis by Qi et al 1 reported that the overall incidence of ONJ in cancer patients receiving denosumab was 1.7% [95% CI: 0.9-3.1%].…”

Section: Discussionmentioning

confidence: 99%

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Denosumab and osteonecrosis of the jaws - the pharmacology, pathogenesis and a report of two cases

O'Halloran

Boyd

Smith³

2014

Aust Dent J

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Denosumab (Amgen, Thousand Oaks, California, USA) is a new bone antiresorptive agent used in patients with osteoporosis or metastatic cancer to the bones. As with the bisphosphonates that are used as antiresorptive medications, denosumab has been associated with osteonecrosis of the jaws (ONJ). Over the past two years there has been an increase in the literature describing ONJ in patients receiving agents such as denosumab. Due to promising study results that demonstrate the effectiveness of denosumab in avoiding skeletal complications related to osteoporosis and metastatic bone disease, more patients will receive denosumab in the future. It is reported that this has the potential to become a comparable challenge to bisphosphonate related osteonecrosis of the jaws (BRONJ) for clinicians. This article describes the management of two patients that developed ONJ while receiving denosumab, reviews the incidence of ONJ associated with denosumab, and contrasts the pharmacokinetics of denosumab and the bisphosphonates. The importance of avoiding interventional dental treatment until denosumab has been withdrawn for six months cannot be overstated.Keywords: Bisphosphonates, bisphosphonate related osteonecrosis of the jaws, denosumab, denosumab associated osteonecrosis of the jaws, necrosis of the jaws.Abbreviations and acronyms: BP = bisphosphonate; BRONJ = bisphosphonate related osteonecrosis of the jaws; DONJ = denosumab associated osteonecrosis of the jaws; FDA = US Food and Drug Administration; ONJ = osteonecrosis of the jaws; OPG = osteoprotegerin; PET = positron emission tomography; RANK = receptor activator of nuclear factor kappa; RANKL = receptor activator of nuclear factor kappa-B ligand.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Denosumab and osteonecrosis of the jaws - the pharmacology, pathogenesis and a report of two cases

O'Halloran

Boyd

Smith³

2014

Aust Dent J

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“…Like bisphosphonates, denosumab has been linked to rare instances of osteonecrosis of the jaw, and in a study of denosumab safety in postmenopausal women with osteoporosis, side effects included infection, eczema, and hypocalcemia [65,66]. The long-term effects of denosumab in skeletally immature pediatric patients are unknown, as is the optimal treatment regimen needed for disease control.…”

Section: Rankl Inhibition and The Role Of Denosumabmentioning

confidence: 99%

Current management of aneurysmal bone cysts

Park

Yang

Sheppard

et al. 2016

Curr Rev Musculoskelet Med

168

259

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Aneurysmal bone cysts (ABCs) are benign bone lesions arising predominantly in the pediatric population that can cause local pain, swelling, and pathologic fracture. Primary lesions, which constitute roughly two thirds of all ABCs, are thought to be neoplastic in nature, with one third of ABCs arising secondary to other tumors. Diagnosis is made with various imaging modalities, which exhibit characteristic features such as Bfluid-fluid levels,^although biopsy is critical, as telangiectatic osteosarcoma cannot be excluded based on imaging alone. Currently, the standard of care and most widely employed treatment is intralesional curettage. However, tumor recurrence with curettage alone is common and has driven some to propose a multitude of adjuvants with varying efficacy and risk profiles. Historically, therapies such as en bloc resection or radiation therapy were utilized as an alternative to decrease the recurrence rate, but these therapies imposed high morbidity. As a result, modern techniques now seek to simultaneously reduce morbidity and recurrence, the pursuit of which has produced preliminary study into minimally invasive percutaneous treatments and medical management.

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“…Numerous reports of BRONJ have been published during the past decade. More recently, denosumab, which has a different mechanism of action from BPs, has been used to control SRE [1,2]; however, reports indicate that denosumab is also associated with osteonecrosis of the jaw (ONJ) [9][10][11][12][13][14][15]. BPs and denosumab are classified as antiresorptives, which have been associated with ONJ.…”

Section: Introductionmentioning

confidence: 99%

Mandibular Osteonecrosis in a Patient Receiving Denosumab and Sunitinib

et al. 2015

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We report a case of osteonecrosis of the jaw (ONJ) in a patient undergoing concurrent treatment with the molecularly targeted agents denosumab and sunitinib for metastatic renal cancer. A 68-year-old man with multiple lung and bone metastases from renal cell carcinoma revisited our institute with exposed bone in the lingual posterior area of the right mandible. The clinical findings were consistent with ONJ according to the diagnostic criteria for bisphosphonate (BP)-related ONJ, although he had not been treated with BPs. His clinical symptoms gradually worsened during conservative treatment with antibiotics; thus, he ultimately underwent surgical treatment after imaging studies confirmed osteomyelitis with necrotic bone and cellulitis of the right mandible. A definitive diagnosis of chronic osteomyelitis with sequestrum formation and no malignancy was made on the basis of histopathological findings. Follow-up clinical and radiological examinations show satisfactory postoperative recovery, and there has been no recurrence of osteonecrosis or osteomyelitis since sequestrectomy, a period of almost 2 years.

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Denosumab-related osteonecrosis of the jaw

Cited by 72 publications

References 7 publications

Denosumab and osteonecrosis of the jaws - the pharmacology, pathogenesis and a report of two cases

Denosumab and osteonecrosis of the jaws - the pharmacology, pathogenesis and a report of two cases

Current management of aneurysmal bone cysts

Mandibular Osteonecrosis in a Patient Receiving Denosumab and Sunitinib

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