Role of Denosumab in the Management of Aneurysmal Bone Cysts

Abstract

Background The management of aneurysmal bone cysts (ABCs) has evolved and less invasive methods have been tried. Denosumab is a monoclonal antibody that inhibits osteoclasts. It is effective in giant cell tumours of bone (GCT) and based on the immunohistochemical similarity and relationship between GCTs and ABCs, Denosumab may also be effective in the treatment of ABCs. Aim of the Work This study aims to assess the therapeutic importance, effectiveness and side effects of denosumab administration in the management of aneurysmal bone cysts. Materials and Methods Embase, Cochrane Library, and MEDLINE/PubMed databases were searched for the articles published from Jan. 2013 to May 2021 that reported the efficacy and safety of denosumab in patients with aneurysmal bone cysts (ABCs). Results Thirteen studies were reviewed, involving a total of 40 patients who had aneurysmal bone cysts and were treated with denosumab. Of the 13 studies, 82.5% of the patients were from case series studies (33 patients) and 17.5% were from case reports (7 patients). The clinical response rate for denosumab as a treatment for aneurysmal bone cysts was 94.7%, with statistical significance (P < .0001). No treatment-related deaths occurred in the reviewed studies. Conclusion We conclude that denosumab represents an effective treatment option for patients with ABC especially when high surgical morbidity is expected. Although denosumab therapy is associated with minimal complications, however, relapse following cessation of treatment is still possible. Finally, denosumab is a potentially safe and promising modality for medically managing ABCs that requires further investigation with prospective clinical trials.