Idiopathic Incidence of MRONJ in Patients on Denosumab

Ibrahim Zakhary, Abraham Khanafer and Moniba Mirkhani

Department of Oral & Maxillofacial Surgery, University of Detroit Mercy School of Dentistry, USA

^*Correspondance to: Ibrahim Zakhary 

 PDF  Full Text DOI: 10.25107/2474-1647.1410

Abstract

Background and
Objectives: Osteonecrosis of the jaw (ONJ) has been reported in patients taking bisphosphonates (BPs) for conditions such as osteoporosis, Paget disease, and hypercalcemia of malignancy. Denosumab, a monoclonal antibody against the receptor activator for nuclear kappa B ligand (RANKL), has been recently approved as a safer alternative antiresorptive agent. However, shortly after its release ONJ has been reported in patients taking denosumab. The aim of this study is to present a case of an idiopathic incidence of osteonecrosis of the jaw related to denosumab. In addition, we are providing a critical review of current literature on denosumab-related osteonecrosis of the jaws.Materials and
Methods: A comprehensive and critical review of literature was conducted on PubMed and Medline using the keywords “denosumab”, “osteonecrosis of the jaw”, “anti-RANKL”, and “MRONJ”. Only confirmed denosumab-related ONJ with no history of BPs and in English language were included in the presented study.Results: Our review of literature identified a total of 18 cases. The majority of cases were reported in posterior mandible of male patients receiving denosumab for treatment of prostate cancer. The most common rendered treatment approach included systemic antibiotics, chlorhexidine (CHX) rinse, discontinuation of denosumab, and surgical debridement.Conclusion: Denosumab-related ONJ appears to be independent of the duration of denosumab therapy. A combination of systemic antibiotics, CHX rinse, discontinuation of denosumab therapy, and surgical debridement were the most commonly rendered treatments.

Keywords

Osteonecrosis of the jaw, Denosumab, Anti-RANKL, MRONJ, Drug holiday

Cite the article

Zakhary I, Khanafer A, Mirkhani M. Idiopathic Incidence of MRONJ in Patients on Denosumab. Clin Surg. 2017; 2: 1410.