6533b7cffe1ef96bd12590dc
RESEARCH PRODUCT
A pragmatic window of opportunity to minimise the risk of MRONJ development in individuals with osteoporosis on Denosumab therapy: a hypothesis
Francesco BertoldoGiuseppina CampisiAlberto BedogniRodolfo MauceriRodolfo MauceriVittorio Fuscosubject
medicine.medical_specialtySide effectOsteoporosisSpecialties of internal medicine030209 endocrinology & metabolismMRONJOral surgery tooth extraction03 medical and health sciences0302 clinical medicineOral surgeryMedication-related osteonecrosis of the jawmedicineDenosumab osteoporosis; Medication-related osteonecrosis of the jaw; MRONJ; Oral surgery tooth extraction; Denosumab; Diphosphonates; Humans; Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density Conservation Agents; OsteoporosisHumansIntensive care medicineGeneral Dentistrytooth extractionBisphosphonate-associated osteonecrosis of the jawDiphosphonatesBone Density Conservation Agentsbusiness.industryHypothesismedicine.diseaseosteoporosisDenosumab osteoporosisBone Density Conservation Agentsstomatognathic diseasesDenosumabOtorhinolaryngologyRC581-951030220 oncology & carcinogenesisDental surgeryOral and maxillofacial surgeryBisphosphonate-Associated Osteonecrosis of the JawNeurology (clinical)DenosumabbusinessOsteonecrosis of the jawmedicine.drugdescription
Abstract 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
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2021-07-09 | Head & Face Medicine |