Case Report: single low-dose of denosumab as a trigger of MRONJ development in a patient with osteoporosis after bisphosphonate therapy

Dávid Száraz; Vojtěch Peřina; Jana Treglerová; Ctirad Macháček; Ondřej Zendulka; Petra Bořilová Linhartová

doi:10.3389/froh.2024.1473049

Case Report: single low-dose of denosumab as a trigger of MRONJ development in a patient with osteoporosis after bisphosphonate therapy

Front Oral Health. 2024 Dec 4:5:1473049. doi: 10.3389/froh.2024.1473049. eCollection 2024.

Authors

Dávid Száraz^{1

2}, Vojtěch Peřina^{1

2}, Jana Treglerová^{1

2}, Ctirad Macháček^{3

4}, Ondřej Zendulka⁵, Petra Bořilová Linhartová^{1

6}

Affiliations

¹ Clinic of Maxillofacial Surgery, University Hospital Brno, Brno, Czechia.
² Clinic of Maxillofacial Surgery, Faculty of Medicine, Masaryk University, Brno, Czechia.
³ Department of Pathology, University Hospital Brno, Brno, Czechia.
⁴ Department of Pathology, Faculty of Medicine, Masaryk University, Brno, Czechia.
⁵ Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czechia.
⁶ RECETOX, Faculty of Science, Masaryk University, Brno, Czechia.

Abstract

Both denosumab (DMB) and bisphosphonates (BPs), antiresorptive drugs (ARDs) used for the treatment of osteoporosis and oncological disorders, are known for their potential to cause medication-related osteonecrosis of the jaws (MRONJ). Besides ARDs, statins were recently associated with MRONJ development, especially in patients taking higher doses of statins for a longer period of time. Here, we report a case of a female patient with osteoporosis using statins and treated with alendronate for 3 years who rapidly developed MRONJ stage III after only a single low dose of DMB. After partial maxillectomy complete healing was observed without any recurrence. We performed a literature review of cases with MRONJ triggered by a single low dose of DMB, with or without previous application of other ARDs. Only six similar cases of patients who developed MRONJ after a single low dose of DMB following previous BP therapy have been reported so far. Besides these, literature reports one patient who developed MRONJ after a single dose of DMB following romosozumab treatment and five cases developing MRONJ after a single dose of DMB even without any previous ARD treatment. We suggest that before DMB therapy is initiated, all factors predisposing to MRONJ development should be considered.

Keywords: MRONJ; bisphosphonates; case report; denosumab; osteonecrosis of the jaw; osteoporosis; single dose; statin.

Publication types

Case Reports

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by a project provided by the University Hospital Brno, Ministry of Health of the Czech Republic—RVO (FNBr, 65269705, SUp 45/23). This work was supported from the European Union’s Horizon 2020 research and innovation program under grant agreement No 857560 (CETOCOEN Excellence). This work was supported from Program JAC - Project SALVAGE, no. CZ.02.01.01/00/22_008/0004644 – co-funded by EU.