Troeltzsch M, Woodlock T, Kriegelstein S, Steiner T Physiology and pharmacology of nonbisphosphonate drugs implicated in osteonecrosis of the jaw. J Can Dent Assoc. 2012; 78
Rogers MJ, Gordon S, Benford HL Cellular and molecular mechanisms of action of bisphosphonates. Cancer. 2000; 88
Colucci S, Minielli V, Zambonin G, Cirulli N, Mori G, Serra M Alendronate reduces adhesion of human osteoclast-like cells to bone and bone protein-coated surfaces. Calcif Tissue Int. 1998; 63:230-235
Boissier S, Magnetto S, Frappart L, Cuzin B, Ebetino FH, Delmas PD Bisphosphonates inhibit prostate and breast carcinoma cell adhesion to unmineralized and mineralized bone extracellular matrices. Cancer Res. 1997; 57:3890-3894
Van der Pluijm G, Vloedgraven H, van Beek E, van der Wee-Pals L, Lowick C, Papapoulos S Bisphosphonates inhibit the adhesion of breast cancer cells to bone matrices in vitro. J Clin Invest. 1996; 98:698-705
Koshihara Y, Kodama S, Ishibashi H, Azuma Y, Ohta T, Karube S. Reversibility of alendronate-induced contraction in human osteoclast-like cells formed from bone marrow cells in culture. J Bone Miner Metab. 1999; 17:98-107
Lippuner K The future of osteoporosis treatment – a research update. Swiss Med Wkly. 2012; 142
Ruggiero S. Osteonecrosis of the jaw: BRONJ and ARONJ. Faculty Dent J. 2014; 5:(2)90-93
Ruggiero SL. Bisphosphonate-related osteonecrosis of the jaw: an overview. Annls NY Acad Sci. 1218:(1)38-46
Arrain Y, Masud T. A current update on osteonecrosis of the jaw and bisphosphonates. Dent Update. 2011; 38:(10)672-676
Oral Health Management of Patients Prescribed Bisphosphonates. 2011;
Peddi P, Lopez-Olivo MA, Pratt GF, Suarez-Almazor ME. Denosumab in patients with cancer and skeletal metastases: a systematic review and meta-analysis. Cancer Treat Rev. 2013; 39:(1)97-104
Qiao GL, Zheng SE, Qi WX, Min DL, Shen Z, Yao Y. Comparison of efficacy and safety of denosumab versus zoledronic acid for treating skeletal-related events caused by bone metastasis in patients with malignant solid tumors and multiple myeloma: a meta-analysis of randomized controlled trials. TUMOR. 2013; 33:(1)48-57
Ford JA, Jones R, Elders A, Mulatero C, Royle P, Sharma P, Mowatt G. Denosumab for treatment of bone metastases secondary to solid tumours: systematic review and network meta-analysis. Eur J Cancer. 2013; 49:(2)416-430
Qi WX, Tang LN, He AN, Yao Y, Shen Z. Risk of osteonecrosis of the jaw in cancer patients receiving denosumab: a meta-analysis of seven randomized controlled trials. Int J Clin Oncol. 2014; 19:(2)403-410
Renton T, Taylor T, Popat S, Popat R, Sivardeen Z, Fogelman I, Coleman R. Oral surgery: ARONJ masterclass. Br Dent J. 2014; 216:(9)488-489
Hellstein JW, Adler RA, Edwards B, Jacobsen PL, Kalmar JR, Koka S, Ristic H. Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis. J Am Dent Assoc. 2011; 142:(11)1243-1251
Rejnmark L, Mosekilde L. New and emerging antiresorptive treatments in osteoporosis. Curr Drug Safety. 2011; 6:(2)75-88
Denosumab, an alternative to bisphosphonates but also associated with osteonecrosis of the jaw – what is the risk? Harlene Kaur Sidhu Dental Update 2024 42:5, 707-709.
Authors
Harlene KaurSidhu
BDS(Birm), MJDF(RCS, Eng), MSc Oral Surg(UCLAN)
The University of Central Lancashire, Lancashire, UK
Most dental professionals will have, or will soon, encounter patients prescribed this novel alternative antiresorptive drug to bisphosphonates, denosumab (Prolia®, Xgeva®). Denosumab is licensed in the UK for the prevention of osteoporotic fractures in postmenopausal women and the prevention of skeletal-related events (SRE) in adults with bone metastases. The presence of osteonecrosis of the jaw in patients receiving non-bisphosphonate antiresorptives has led to the introduction of the term antiresorptive-related osteonecrosis of the jaw or ARONJ. This paper discusses the basic physiology of bone remodelling, the pharmacology of bisphosphonates and denosumab, and the risk of ARONJ.
CPD/Clinical Relevance: What is the potential risk of ARONJ arising from dental treatment that we should be advising for our patients?
Article
Most dental professionals will have, or will soon, encounter patients prescribed this novel alternative antiresorptive drug to bisphosphonates, denosumab (Prolia®, Xgeva® by Amgen) that is administered through subcutanous injection. Denosumab is a monoclonal human antibody that inhibits osteoclast formation, function and survival, thereby decreasing bone resorption.1
Denosumab is licensed in the UK for:
Remodelling of bone is essential for reshaping of the growing skeleton and healing of bone during injury, for example tooth extraction. Bone remodelling is controlled by systemic and local factors:
Remodelling of bone is a balance between bone deposition and resorption. The three central cells to bone remodelling are:
Osteoblasts differentiate from osteocytes and are the key bone-forming cells. Osteocytes maintain ion control and stress communication within bone. Osteoclasts are responsible for bone resorption and originate from the monocyte-macrophage lineage under the influence of cytokine growth factors, especially macrophage colony-stimulating factor (M-CSF), receptor activator of nuclear factor κ-B ligand (RANKL) and vascular endothelial growth factor (VEGF).4
Register now to continue reading
Thank you for visiting Dental Update and reading some of our resources. To read more, please register today. You’ll enjoy the following great benefits:
