The relationship of denosumab pharmacology and osteonecrosis of the jaws

Denosumab is a new bone antiresorptive agent that has received approval by the Food and Drug Administration for use in patients with osteoporosis and metastatic cancer to the bones. Like the bisphosponates that are used as antiresorptive medications, denosumab has been associated with osteonecrosis...

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Bibliographic Details
Published in:Oral surgery, oral medicine, oral pathology and oral radiology oral medicine, oral pathology and oral radiology, 2012-12, Vol.114 (6), p.671-676
Main Authors: Malan, John, DDS, Ettinger, Kyle, DDS, Naumann, Erich, DMD, Beirne, O. Ross, DMD, PhD
Format: Article
Language:English
Subjects:
Antibodies, Monoclonal, Humanized - pharmacokinetics
Antibodies, Monoclonal, Humanized - therapeutic use
Biological and medical sciences
Denosumab
Dentistry
Diseases of the osteoarticular system
Humans
Immunomodulators
Jaw Diseases - diagnostic imaging
Jaw Diseases - drug therapy
Medical sciences
Osteonecrosis - diagnostic imaging
Osteonecrosis - drug therapy
Otorhinolaryngology. Stomatology
Pharmacology. Drug treatments
Radiography, Panoramic
Surgery
Vascular bone diseases
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Summary:Denosumab is a new bone antiresorptive agent that has received approval by the Food and Drug Administration for use in patients with osteoporosis and metastatic cancer to the bones. Like the bisphosponates that are used as antiresorptive medications, denosumab has been associated with osteonecrosis of the jaws (ONJ). However, because the pharmacodynamics and pharmacokinetics of denosumab differ from that of the bisphosphonates, ONJ related to denosumab may resolve more rapidly with a drug holiday than bisphosphonate-related osteonecrosis of the jaws (BRONJ). This paper describes the management of a patient who developed ONJ while receiving denosumab, reviews the incidence of ONJ associated with denosumab, and compares the pharmacology of denosumab and the bisphosphonates. Because the effects of denosumab on bone turnover are more rapidly reversible than the effects of the bisphosphonates, ONJ related to denosumab may resolve more quickly with a drug holiday than BRONJ.
ISSN:2212-4403
2212-4411
DOI:10.1016/j.oooo.2012.08.439