Abstract
Denosumab has proved effective at low doses in increasing bone mineral density in osteoporosis patients. In contrast to high-doses antiresorptive therapy, denosumab has a transient effect on the inhibition of the bone remodeling process, suggesting that denosumab-related osteonecrosis is a self-limiting disease, with a high curative potential of surgery when performed after a proper duration of receptor activator of nuclear factor-kB ligand (RANKL) inhibitor suspension. We report the long-term clinical and radiological (Computed Tomography—CT scan) data of a patient affected by secondary osteoporosis (cancer treatment-induced bone loss—CTIBL for metastatic breast cancer) who underwent surgical treatment for stage II denosumab-related osteonecrosis of the upper maxilla 7 months after denosumab suspension. A minimally invasive approach was performed with the extraction of the first right upper molar and debridement of the surrounding alveolar bone. After surgery, the patient was followed up at three-month intervals up to 1 year, and clinical and radiological data (CT scan) were recorded at each follow-up for the early detection of signs of recurrent disease. The mucosal healing remained stable in the long term, with radiological signs of bone remodeling in the post-operative site since the 6-month follow-up. The presented case strengthens the hypothesis that denosumab induces temporary alterations of bone turnover with a predictable curative effect of minimal surgical procedures in cases of denosumab-related osteonecrosis of the jaw.
Highlights
Unit of Maxillofacial Surgery, Department of Neurosciences, University of Padua, Via Giustiniani 2, Regional Centre for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, Unit of Maxillofacial Surgery, Department of Neuroscience, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
The presented case strengthens the hypothesis that denosumab induces temporary alterations of bone turnover with a predictable curative effect of minimal surgical procedures in cases of denosumab-related osteonecrosis of the jaw
We report the 1-year clinical and radiological follow-up of a breast cancer patient with cancer treatment-induced bone loss (CTIBL), who had been surgically treated for DNB-related osteonecrosis of the upper maxilla seven months after the last dose of DNB
Summary
A 54 year old women was referred to our Regional Centre at the Unit of Maxillofacial. At the 6-month post-operative CT scan, new bone formation was observed in the alveolar socket of the first right upper molar, with a regular trabecular pattern. No signs of bone marrow sclerosis were detected at the right upper molar area (Figure 5a). CT axial scan clear aspects of newly formed alveolar bone at the site of surgery (first right upper molar); a residual cortical interruption is maintained in. The presented case strengthens the hypothesis that temporary discontinuation of to the contralateral site and resulting from bone repair (white arrowhead); the posterior region of denosumab, when canbone facilitate boneand healing and reduce the invasiveness of the upper right jawappropriate, showed a regular architecture trophism. Surgery in patients with denosumab-related osteonecrosis of the jaw
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