Rapid onset of osteonecrosis of the jaw in patients switching from bisphosphonates to denosumab

Publication date: Available online 28 September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Noam Yarom, Towy Sorel Lazarovici, Sara Whitfield, Tal Weissman, Oshri Wasserzug, Ran Yahalom
ObjectiveTo determine whether osteonecrosis of the jaw (ONJ) developed more rapidly in patients who switched from bisphosphonates (BP) treatment to denosumab compared to patients using only denosumab.Study designA retrospective cohort study conducted at a tertiary referral center. Thirty one ONJ patients met the inclusion criteria.ResultsTwenty-two patients who had been on BP were switched to denosumab (BP+D), while 9 patients received only denosumab. Both groups were similar for the known ONJ risk factors of age, diabetes mellitus and smoking. The number and cumulative doses of denosumab before the onset of ONJ symptoms were significantly lower among the BP+D group compared to the denosumab only group (P=.025 and .018, respectively). Nine patients (41%) of the BP+D group developed ONJ symptoms following the administration of ≤3 denosumab doses, compared to only 1 patient (11%) who was naïve to BP. ONJ developed spontaneously without any known triggering event in 72.7% of patients in the BP+D group and in 77.8% of patients in the denosumab group.ConclusionsDenosumab induced ONJ might develop rapidly in patients previously treated with BP. ONJ developed spontaneously in most patients treated with denosumab. In light of our small sample, these conclusions should be further investigated.



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