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. 2023 Jun 30;45(1):23.
doi: 10.1186/s40902-023-00391-9.

Denosumab-associated jaw bone necrosis in cancer patients: retrospective descriptive case series study

Ji-Yeon Kang  1 , Sang-Yup Kim  2   3 , Jae-Seok Lim  4 , Jwa-Young Kim  5 , Ga-Youn Jin  6 , Yeon-Jung Lee  6 , Eun-Young Lee  7   8
Affiliations

Denosumab-associated jaw bone necrosis in cancer patients: retrospective descriptive case series study

Ji-Yeon Kang et al. Maxillofac Plast Reconstr Surg. .

Abstract

Background: Denosumab (DMB) is a bone antiresorptive agent used to treat osteoporosis or metastatic cancer of the bones. However, denosumab-associated osteonecrosis of the jaw (DRONJ) has become a common complication in cancer patients. The prevalence of osteonecrosis of the jaw (ONJ) in cancer patients is estimated to be similar for both bisphosphonate-related cases (1.1 to 1.4%) and denosumab-related cases (0.8 to 2%), with the addition of adjunctive therapy with anti-angiogenic agents reportedly increasing its prevalence to 3%. (Spec Care Dentist 36(4):231-236, 2016). The aim of this study is to report on DRONJ in cancer patients treated with DMB (Xgeva®, 120mg).

Case presentation: In this study, we identified four cases of ONJ among 74 patients receiving DMB therapy for metastatic cancer. Of the four patients, three had prostate cancer and one had breast cancer. Preceding tooth extraction within 2 months of the last DMB injection was found to be a risk factor for DRONJ. Pathological examination revealed that three patients had acute and chronic inflammation, including actinomycosis colonies. Among the four patients with DRONJ referred to us, three were successfully treated without complications and had no recurrence following surgical treatment, while one did not follow up. After healing, one patient experienced a recurrence at a different site. Sequestrectomy in conjunction with antibiotic therapy and cessation of DMB use proved to be effective in managing the condition, and the ONJ site healed after an average 5-month follow-up period.

Conclusion: Conservative surgery, along with antibiotic therapy and discontinuation of DMB, was found to be effective in managing the condition. Additional studies are needed to investigate the contribution of steroids and anticancer drugs to jaw bone necrosis, the prevalence of multicenter cases, and whether there is any drug interaction with DMB.

Keywords: Anticancer drug; Cancer; Denosumab; Denosumab-related osteonecrosis of the jaws; Necrosis of the jaws.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Non-healed state of the spontaneous removal site of #46 implant. A Intraoral photo. Inflammatory state on the spontaneous removal implant. B A panoramic view on the first visit. Non-healed state of the removal site of #46 implant
Fig. 2
Fig. 2
Preoperative state. After 4 months of conservative treatment. A Intraoral photo. B Facial photo. Erythematous and inflamed in the right buccal cheek area. C A panoramic view. Sequestra formation on Rt. mandibular posterior area
Fig. 3
Fig. 3
Necrotic bone fragment
Fig. 4
Fig. 4
Intraoperative photo of debridement
Fig. 5
Fig. 5
Postoperative 2 months. A Complete closure state of the intraoral oral area. B Panoramic view. It showed the defect has not been fully closed to date
Fig. 6
Fig. 6
A Panoramic view on the first visit. Alveolar bone inflammation was observed in the socket of tooth #47. B A 7-month postoperative panoramic view. Signs of bony infill were observed at the site of the #47 socket
Fig. 7
Fig. 7
Panoramic radiograph on the first visit. Radiolucent periapical lesion around the #41-33 region and ill-defined bone loss
Fig. 8
Fig. 8
Postoperative 5 months. A Mild gingival swelling and bone exposure in the left posterior mandibular region. B Panoramic radiograph. Radiolucent periapical lesion in the left posterior mandibular region
Fig. 9
Fig. 9
Panoramic radiograph. Osteomyelitis around the socket of the right anterior maxilla after tooth extraction, as well as a radiolucent lesion below the #44 implant
See this image and copyright information in PMC

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