Particularly, medication-related osteonecrosis of the jaw (MRONJ) is one of the most controversial side effects of bone resorption inhibitors 8, 9. However, denosumab must also be evaluated in light of the issues surrounding the use of bone resorption inhibitors, including bisphosphonate. Compared to bisphosphonate’s mechanism of reducing bone resorption by inhibiting differentiation and maturation of osteoclasts and inducing apoptosis 6, denosumab reduces bone resorption and increases bone strength by inhibiting the differentiation and function of osteoclasts as a single cell antibody against RANKL 7. Denosumab is suggested as a first-line therapy for postmenopausal osteoporosis patients with high risk of fracture 4, 5. MRONJ cases reported in this study show that MRONJ can develop as chronic inflammation without invasive dental treatment therefore, implementing preventive dental treatment before initiating denosumab treatment is necessary to reduce the occurrence of MRONJ.īisphosphonates and the receptor activator of nuclear factor-κB ligand (RANKL) inhibitor denosumab are the most common anti-resorptive agents used in the treatment of osteoporosis 1, 2, 3. The other patient underwent a tooth extraction without osteoporosis treatment, and non-identified MRONJ developed after denosumab administration. Two out of 4 patients developed MRONJ regardless of invasive treatment after denosumab administration and proceeded with extraction one patient developed MRONJ after denosumab administration and extraction. There was no significant difference between groups in the occurrence of MRONJ and factors affecting MRONJ. The participants were divided into two groups: receiving only denosumab (n = 51) and receiving bisphosphonate as first treatment and denosumab as second treatment (n = 47). Four of the 98 patients developed MRONJ before and after tooth extraction. The purpose of this study was to report denosumab induced MRONJ cases, and investigate the factors affecting the occurrence of MRONJ in patients who underwent denosumab and invasive dental treatment (especially tooth extraction) between October 2016 and March 2020. However, a standardized protocol for the prevention of denosumab induced medication-related osteonecrosis of the jaw (MRONJ) has not yet been established. Denosumab has been suggested as a first-line therapy for osteoporotic patients.
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