Jaw osteonecrosis rare following denosumab use

Though relatively rare, medication-related osteonecrosis of the jaw (MRONJ) can nevertheless occur after denosumab treatment, even in the absence of invasive dental treatment, reports a recent study.

Researchers conducted a retrospective analysis of 98 osteoporosis patients (mean age 70.47 years, 88.8 percent women) who had been treated with either denosumab alone (n=52) or in combination with a bisphosphonate (n=46); all participants also had a history of invasive dental treatments. MRONJ stage, location, and contributing factors were assessed.

Overall, four participants were diagnosed with MRONJ, two of whom had been medicated with denosumab alone, while the other two received both denosumab and a bisphosphonate. Incidence rates of MRONJ did not significantly differ between the two cohorts.

In terms of predisposing local factors, two patients developed MRONJ due to a worsening of the chronic inflammation of existing lesions after denosumab treatment. Meanwhile, MRONJ arose in one patient because of tooth extraction. The cause of MRONJ was unidentified in the final patient.

According to the researchers, these findings suggest that chronic and active periodontitis, as well as other local inflammatory lesions, may be an important risk factor for MRONJ.

“Before the initiation of denosumab therapy, it is necessary to control existing inflammatory lesions through the preventive dental care,” the researchers said, pointing out that careful consensus between physicians and dentist regarding drug changes during denosumab therapy is also important.

“In addition, continuous periodic dental management needs to be performed during denosumab treatment to prevent nonidentified MRONJ. In the future, further multicenter or molecular biological studies are needed,” they noted.