Abstract
Bisphosphonates have been used for years in the treatment of patients with distant bony metastasis and in the prevention of osteoporosis. One of main side effects of these medications is the development of bisphosphonate related osteonecrosis of the jaw (BRONJ) in a small subset of patients. A new class of medications with a shorter half-life, known as receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitors, was introduced with the hopes of avoiding this side effect. However, reports of osteonecrosis of the jaw after the use of RANKL inhibitors have also been documented. We report on a patient who developed a life threatening osteonecrosis of the jaw with sepsis shortly after switching from a bisphosphonate to a RANKL inhibitor for osteoporosis treatment. This patient developed several soft tissue defects including spontaneous necrosis of the soft palate. To our knowledge this is the first time this presentation has been described.
Highlights
Bisphosphonate (BP) medications have significantly improved the quality of life of patients suffering from skeletal metastases such as in the cases of prostate cancer, breast cancer, and multiple myeloma [1]
We present a patient who developed an advanced case of medication related osteonecrosis of the jaw (MRONJ) shortly after switching from BPs to Denosumab for the treatment of osteoporosis
Denosumab is a competitive antagonist of the cytokine receptor activator of nuclear factor kappa-B ligand (RANKL), which is integral to the differentiation and function of osteoclasts
Summary
Bisphosphonate (BP) medications have significantly improved the quality of life of patients suffering from skeletal metastases such as in the cases of prostate cancer, breast cancer, and multiple myeloma [1]. Denosumab is a human monoclonal antibody that binds to and inhibits the cytokine RANKL, which is an essential mediator in the formation, function, and survival of osteoclasts [6, 9, 10] This exerts a potent antiresorptive effect which is helpful in reducing skeletal related events (SREs) in cancer and osteoporosis patients. We present a patient who developed an advanced case of medication related osteonecrosis of the jaw (MRONJ) shortly after switching from BPs to Denosumab for the treatment of osteoporosis. This patient went on to develop life threatening sepsis and an unexplained soft tissue defect in her soft palate. To our knowledge this is the first time this presentation has been reported
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