Osteonecrosis of the jaw and denosumab

Fig 1 - Stage 2 medication-related osteonecrosis of the jaw Note sequestrum Comment Despite having no clear guidelines to favour denosumab, it has substantially replaced the oral bisphosphonates as the first-line treatment for osteoporosis in Australia.1 Denosumab is effective when given as a six-mo...

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Bibliographic Details
Published in:Australian prescriber 2022-12, Vol.45 (6), p.208-209
Main Author: Goss, Alastair N
Format: Article
Language:English
Subjects:
Bisphosphonates
Cardiovascular disease
Dental implants
Hypothyroidism
Jaw
Medicinal Mishap
Monoclonal antibodies
Necrosis
Osteoporosis
Patients
Surgery
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Summary:Fig 1 - Stage 2 medication-related osteonecrosis of the jaw Note sequestrum Comment Despite having no clear guidelines to favour denosumab, it has substantially replaced the oral bisphosphonates as the first-line treatment for osteoporosis in Australia.1 Denosumab is effective when given as a six-monthly 60 mg subcutaneous injection and has few adverse reactions. If there is uncertainty about bone turnover, it should be measured at the time of the extraction.3 The Box shows evidence-based recommendations drawn from a prospective trial of 546 patients taking denosumab for osteoporosis, who had 1082 dental extractions, and another study of 13 patients who developed osteonecrosis.4,5 Besides dental extractions, another risk group is patients with dental implants that sometimes lose integration during antiresorptive treatment. Box - Recommendations for dental care in patients treated with denosumab4,5 Risk factors Factors include being female, aged over 70 years, having comorbidities, and taking antiresorptive drugs for over four years.
ISSN:0312-8008
1839-3942
DOI:10.18773/austprescr.2022.066