Medication-Related Osteonecrosis of the Jaw by Concomitant Nivolumab and Denosumab Treatment

Abstract

Medication-related osteonecrosis of the jaw is a multifactorial disease described in association with antiresorptive drugs, such as bisphosphonates and denosumab. More recently, cases due to non-antiresorptive medications, particularly, some cases by immune checkpoint inhibitors, have also been reported. Dentists and oral surgeons in the coming years will see an increasing number of patients who are receiving treatment potentially toxic to bone. We reported a case of a cancer patient treated with denosumab that presented MRONJ following treatment with nivolumab, with the onset of symptoms after three months (four doses) of drug. According revised literature, the physiopathological mechanisms, clinical and therapeutic aspects are discussed.