Denosumab-related osteonecrosis of the jaw in a patient with bone metastases of prostate cancer: A case report and literature review

Yoshimura,Hitoshi; Ohba,Seigo; Yoshida,Hisato; Saito,Kyoko; Inui,Kazuyoshi; Yasui,Rie; Ichikawa,Dai; Aiki,Minako; Kobayashi,Junichi; Matsuda,Shinpei; Imamura,Yoshiaki; Sano,Kazuo

doi:10.3892/ol.2017.6121

Denosumab-related osteonecrosis of the jaw in a patient with bone metastases of prostate cancer: A case report and literature review

Authors:
- Hitoshi Yoshimura
- Seigo Ohba
- Hisato Yoshida
- Kyoko Saito
- Kazuyoshi Inui
- Rie Yasui
- Dai Ichikawa
- Minako Aiki
- Junichi Kobayashi
- Shinpei Matsuda
- Yoshiaki Imamura
- Kazuo Sano
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Affiliations: Department of Dentistry and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui 910‑1193, Japan, Department of Regenerative Oral Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852‑8588, Japan, Division of Surgical Pathology, University of Fukui Hospital, Fukui 910‑1193, Japan
Published online on: May 4, 2017 https://doi.org/10.3892/ol.2017.6121
Pages: 127-136
Copyright: © Yoshimura et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Denosumab, a human monoclonal antibody directed against the receptor activator of nuclear factor-κβ ligand (RANKL), is used for the treatment of patients with metastatic cancer of the bone or osteoporosis. Recent reports have demonstrated that denosumab can induce osteonecrosis of the jaw (ONJ), but reported cases of this are uncommon. The present study reports the case of an 86‑year‑old male with prostate cancer patient exhibiting bone metastases who developed ONJ whilst receiving denosumab. To elucidate the influence of denosumab on the development of ONJ, the present study also reviewed the literature, including clinical trials and case reports. In the clinical trials, the prevalence of denosumab‑related ONJ was higher in patients with cancer compared with those with osteoporosis. The high risk of ONJ in patients with cancer was thought to be associated with the differing dose and frequency of denosumab administration. The prevalence of ONJ was not significantly different between patients receiving denosumab and bisphoshonate (BP). In the reported cases, denosumab‑related ONJ had a similar clinical presentation to BP‑related ONJ. There was also a tendency for denosumab‑related ONJ to develop in the mandible of elderly patients. Previous invasive dental treatment was a commonly shared characteristic of patients with denosumab‑related ONJ. A complex medical history was also suspected to affect the prevalence. No clear association between the dose or duration of denosumab treatment and the development of ONJ was observed. Although conservative treatments are given for denosumab‑related ONJ, non‑improving cases were managed surgically with primarily positive results. Because denosumab may offer superior results compared with BP for the treatment of metastatic cancer of the bone or osteoporosis, the use of denosumab is expected to increase in the near future. Clinicians should also be aware of the risk factors for denosumab‑related ONJ, in order to aid in its diagnosis. In addition, patients treated with denosumab should receive prophylactic treatment to maintain their oral health prior to, during and after denosumab treatment.

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