Case reportOsteonecrosis of the Jaw After Osteoporosis Therapy With Denosumab Following Long-term Bisphosphonate Therapy
Section snippets
Case Report
We describe a 75-year-old woman in whom ONJ developed after the first subcutaneous injection of denosumab. She had previously sustained osteoporotic fractures of the proximal humerus and the hip while taking alendronate, 70 mg/wk, for more than 3 years. Her medical history included unclassified inflammatory bowel disease, previous glucocorticoid therapy, impaired renal function with a glomerular filtration rate of 50 mL/min, and chronic anemia for decades without the need for transfusions. The
Conclusion
Findings from this case, the first with denosumab in Germany, and the registry data emphasize the role of comorbidities in the pathogenesis of ONJ. It is important to raise awareness that medical conditions or comedications increase the risk of ONJ in patients receiving any form of antiresorptive treatment for osteoporosis.
References (5)
- et al.
FRAX and its applications to clinical practice
Bone
(2009) - et al.
Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research
J Bone Miner Res
(2007)
Cited by (37)
Denosumab related osteonecrosis of the jaw: Unusual pattern with periosteal reaction
2022, European Journal of CancerPractical Guidance for Prevention and Management of Glucocorticoid-Induced Osteoporosis for the Allergist/Immunologist
2021, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :There is no increase in infection rates, and denosumab is favored in subjects with chronic renal disease. ONJ and atypical fractures are also rare but reported.83 If inadvertently discontinued, there is concern of “severe rebound-associated vertebral fractures” with worsening bone loss.84,85
Comparing the Surgical Response of Bisphosphonate-Related Versus Denosumab-Related Osteonecrosis of the Jaws
2021, Journal of Oral and Maxillofacial SurgeryCitation Excerpt :The bisphosphonate family is composed of a variety of small chemical compounds, with a common phosphate-carbon-phosphate molecular core. These chemicals covalently bind to the hydroxyapatite matrix of bone and may remain present and active for decades.28 In the acidic environment created by resorbing osteoclasts, the bisphosphonates are released from bone, cross the osteoclast membrane, and inhibit their function.
Osteonecrosis of the jaw in patients treated with denosumab: A multicenter case series
2018, Journal of Cranio-Maxillofacial SurgeryCitation Excerpt :An almost-similar finding was noted in our case series (16.4 doses). On the other hand, Rachner et al. reported DRONJ in osteoporosis patients after only a single dose of 60 mg denosumab (Rachner et al., 2013); however, this patient had been previously taking alendronate for 3 years. In this cohort, patients with previous use of bisphosphonates developed DRONJ after a slightly lower number of denosumab doses than those without (15.3 doses versus 17.5 doses).
What is the effect of anti-resorptive drugs (ARDs) on the development of medication-related osteonecrosis of the jaw (MRONJ) in osteoporosis patients: A systematic review
2017, Journal of Cranio-Maxillofacial SurgeryDrug induced osteonecrosis of the jaw
2015, Cancer Treatment ReviewsCitation Excerpt :In the osteoporosis setting, not a single case of ONJ was detected in any of the randomized clinical studies seeking to evaluate efficacy of denosumab [39,40,45]. After performing a search in PubMed, we were able to identify 8 case reports [46–52] of denosumab related ONJ, of which 4 occurred 2–4 months after tooth extraction in patients treated with denosumab for osteoporosis at the FDA approved dose (60 mg every 6 months). Due to the lack of solid evidence from clinical studies, the prevalence of ONJ among patients treated with denosumab for osteoporosis is difficult to assess or estimate.
Grant Support: The work was supported by grants RA 2151/2-1 (T.D.R., L.C.H.) and HO 1875/12-1 and 13-1 (Forschergruppe-1586 SKELMET) (L.C.H.) from Deutsche Forschungsgemeinschaft.
Potential Competing Interests: Dr Rachner has received an unrestricted research grant from Amgen (to the institution) and travel grants from Novartis (individually). Dr Platzbecker has received consulting fees and lecture honoraria from Amgen, Celgene, GlaxoSmithKline, Janssen, and Novartis (both to the institution and individually) and research support from GlaxoSmithKline and Celgene (to the institution). Dr Felsenberg has received consulting fees and lecture honoraria from Amgen, Eli Lilly & Co, Merck, Novartis, Servier, Takeda, TEVA, and Roche (individually) and research support from Amgen, Merck, Novartis, Servier, Takeda, and TEVA (to the institution). Dr Hofbauer has received consulting fees and lecture honoraria from Amgen, Merck, and Novartis (both to the institution and individually) and research support from Amgen and Novartis (to the institution).