Clinical Assessment of the Treatment of 18 Cases of Denosumab-related Osteonecrosis of the Jaw （DRONJ）

Abstract

This study aimed to evaluate the treatment outcome of osteonecrosis of the jaw （ONJ） in 18 patients receiving only denosumab. The patients comprised 11 males and seven females, with a median age of 82.5 years and mean age of 77.9 years. Fifteen patients were cancer patients with bone metastasis and three had osteoporosis. Stage 2 was the most common stage （77.8％）. Of the 18 patients, surgical treatment was performed in five patients, while purely conservative treatment was performed in 13. Surgical treatment achieved complete mucosal healing in 100％ （5/5） and was significantly correlated with treatment outcome on univariate analysis. In purely conservative treatment, two patients achieved complete mucosal healing and two patients achieved partial ONJ resolution. The treatment efficacy rate of conservative treatment was 30.8％ （4/13）. In four patients who were effectively treated by conservative treatment, their sequestrums detached spontaneously and epithelialized after a median of 12.5 months and mean of 15 months of discontinuing denosumab. ONJ progressed or was unchanged in five patients even after discontinuation of denosumab treatment. It may take a long time even if conservative treatment is successful. We recommend surgical treatment even for denosumab related osteonecrosis of the jaw when patients can tolerate surgery.