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Osteonecrosis of the jaw (ONJ) following bisphosphonate use is well documented. However, to our knowledge, there are few cases reported on ONJ related to the use of other pharmaceutical agents, such as denosumab – a monoclonal antibody that is prescribed for the treatment of osteoporosis and is used as an anti-cancer agent. Here we present the first case in the UK of a patient who has developed ONJ following treatment with denosumab. The purpose of this report is to highlight the potential effects of this monoclonal antibody on bone turnover and the subsequent results of osteonecrosis of the jaw. It is hoped that this will allow early recognition by medical and dental practitioners, and appropriate referral and treatment.
Clinical Relevance: Readers should be aware of other causes of osteonecrosis of the jaw.
Article
Denosumab (Prolia®) is a monoclonal antibody that lowers osteoclast activity, by inhibiting RANK-L during osteoclastogenesis and therefore reduces bone resorption.1 In the UK, it has been authorized for the treatment of osteoporosis. It is recommended as a treatment option for the primary prevention of osteoporotic fragility fractures in post menopausal women, who are non-compliant, intolerant or have a contra-indication to bisphosphonate use. It is administered as a single subcutaneous injection into the thigh, abdomen or back of the arm. The recommended dosage is 60 mg every six months.2 The drug is also administered at higher dosages of up to 180 mg every four weeks for other conditions, including bone metastases, multiple myeloma and bone loss in men with hormone ablation in prostate cancer.3
Reported side-effects associated with denosumab treatment include arthralgia, upper respiratory tract infections and cellulitis.4 ONJ has been seen in patients taking denosumab who have received higher doses of the drug in advanced cancer treatment.5 ONJ in women receiving denosumab for post menopausal osteoporosis is rare; currently there are no cases reported in the UK.
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