Case report
Osteonecrosis of the Jaw After Osteoporosis Therapy With Denosumab Following Long-term Bisphosphonate Therapy

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Abstract

Osteonecrosis of the jaw (ONJ) is a common and potentially severe complication of antiresorptive therapy for bone metastases. However, its occurrence in patients treated for osteoporosis is rare. Although poor oral hygiene and invasive dental procedures have been identified as potential triggers, little is known about the role of other systemic risk factors. We describe a patient who developed ONJ after her first treatment with denosumab, a monoclonal antibody against receptor activator of NF-κB ligand. This patient had several comorbidities that prompted us to assess the German ONJ registry for the incidence of comorbidities in patients with ONJ. In summary, almost half of the patients (35 of 86 [41%]) had 1 or more risk factors thought to increase the risk of ONJ. In conclusion, comorbidities or comedications may increase the susceptibility of developing ONJ during osteoporosis 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.

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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).

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