A pragmatic window of opportunity to minimise the risk of MRONJ development in individuals with osteoporosis on Denosumab therapy: a hypothesis

Head & Face Medicine

Francesco Bertoldo¹  Giuseppina Campisi²  Rodolfo Mauceri³  Vittorio Fusco⁴  Alberto Bedogni⁵ 

[1] Department of Medicine, University of Verona, Verona, Italy;Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy;Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy;Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy;Oncology Unit, Azienda Ospedaliera di Alessandria SS, Antonio e Biagio e Cesare Arrigo, Alessandria, Italy;Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padua, Padua, Italy;

关键词: Medication-related osteonecrosis of the jaw;    MRONJ;    Denosumab, osteoporosis;    Oral surgery, tooth extraction;   

DOI  :  10.1186/s13005-021-00280-4

来源: Springer

【 摘 要 】

Denosumab is associated with the development of medication-related osteonecrosis of the jaw (MRONJ), an uncommon but severe oral side effect with a higher prevalence in metastatic cancer patients than in patients with metabolic bone fragility. Although several oral triggers can initiate MRONJ, invasive oral treatments and tooth extraction still remain the most common precipitating event. In general, tooth extraction and oral surgery should be avoided in patients at increased risk of MRONJ, while extraction of non-restorable teeth should be performed based on specific risk reduction protocols to eliminate dental/periodontal infections, still protecting from MRONJ onset.Based on the different pharmacological activity of denosumab and nitrogen-containing bisphosphonates, it is likely that the MRONJ risk profile of patients with osteoporosis could somewhat vary.We hypothesize the chance to maximize the pharmacokinetic of denosumab 60 mg (Prolia®) and identify a time interval in which invasive oral treatments can ideally take place without restrictions in patients with metabolic bone fragility,We propose that dental surgery (e.g. tooth extraction) may be safely performed without additional intra or peri-operative procedures in osteoporosis patients using denosumab provided that careful case selection, adequate communication among specialists, planning of a delayed dosing window (1-month deferral) and rigorous postoperative follow-up are granted.Graphical abstract

【 授权许可】

CC BY