Denosumab-related osteonecrosis of the jaw
a systematic review
DOI:
https://doi.org/10.5935/2525-5711.20200026Keywords:
Denosumab, RANK Ligand, Osteonecrosis, Adverse effects, Oral medicineAbstract
Denosumab (DNB) is a human monoclonal antibody, successfully used for the treatment of osteoporosis and some types of malignant neoplasms. Nevertheless, medication-related osteonecrosis of the jaw (MRONJ) is one of its possible side effects. The aim of this study was to summarize the etiology, characteristics, treatment options and prognosis of MRONJ caused by DNB through a systematic review of reported cases. A search was conducted on the Pubmed, Scopus, and Scielo databases, including case reports and case series articles, published until October 2019 about the effect of this drug in the oral and maxillofacial area. Forty-three articles were included, totaling 145 reported cases of MRONJ cases related to DNB. The mean age of the patients was 68.3 years, and the mandible was more affected than the maxilla. The most common triggering factor was dental extractions (60%), although it could happen spontaneously. The prescription of antibiotics and oral rinses, followed by removal of necrotic bone were performed in most articles (106 cases, 73%). In 68.9% of these surgical cases, a total remission of MRONJ was seen. Onset of MRONJ led to discontinuation of denosumab DNB in 42% of the cases. Adjuvant therapies have also been reported to increase treatment success. The increased use of DNB in the treatment of cancer, osteoporosis and other bone conditions highlights the importance of knowing the characteristics DNB-related MRONJ, the possibility of prevention and its treatment options. This review showed that this condition can be controlled with antibiotic therapy, mouthwashes and removal of devitalized bone. Apparently, the use of teriparatide or leucocyte- and platelet-rich fibrin could also contribute to its resolution. However, clinical studies have yet to be performed to support the findings of this systematic review of case reports.
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Copyright (c) 1969 Patricia Verónica Aulestia-Viera, Alan Roger Santos-Silva, Gustavo Grothe Machado, André Caroli Rocha
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