Denosumab, an alternative to bisphosphonates but also associated with osteonecrosis of the jaw — what is the risk?

A selection of abstracts of clinically relevant papers from other journals. The abstracts on this page have been chosen and edited by John R. Radford.

Abstract

Dental health to be secured before and during denosumab therapy.

Main

Sidhu HK. Dent Update 2015; 42: 436–440

Correspondence in the Letters section of this Journal (eg Br Dent J 2014; 217: 258–259) have reported that new drugs, such as denosumab (Prolia®, XGEVA®), and the antiangiogenic agents bevacizumab (Avastin®) and sunitinib (Sutent®), of course in addition to bisphosphonates, are associated with osteonecrosis of the jaw (ONJ). This review describes the mechanisms of action and therapeutics of denosumab and bisphosphonates. Denosumab is a monoclonal human antibody that has bone antiresorptive properties. It is used to prevent osteoporotic fractures in postmenopausal women who cannot take bisphosphonates, and prevention of skeletal-related events in adults with bone metastases. In the above cited correspondence, it was stated the 'risk of ONJ is about 1% for cancer patients receiving intravenous BPs (zole(n)dronate), and there is a comparable figure for cancer patients exposed to denosumab'. A key difference between denosumab and zoledronic acid, is that the effects of denosumab are reversed after six months. Although controversial, drug-holidays for those on denosumab (and sunitinib) for whom dental surgery is indicated are not discussed.