Denosumab-related osteonecrosis of the jaw: thinking from the direction of osteoclast targeted therapy

doi:10.3969/j.issn.2095-4344.1394

Abstract

Abstract:

BACKGROUND: Denosumab is a monoclonal antibody agent for treating osteoporosis. It targets the RANKL/RANK signaling pathway, which is the core pathway of bone metabolism. Denosumab has been approved for listing in the US in 2010, and has been applied to the first-line treatment for postmenopausal osteoporosis currently. Denosumab-related osteonecrosis of the jaw is one of the serious adverse effects of denosumab, which severely affects patients’ quality of life.
OBJECTIVE: To review the possible mechanisms and treatment of denosumab-related osteonecrosis of the jaw.
METHODS: The first author retrieved the literature related to denosumab-related osteonecrosis of the jaw in the PubMed and WanFang databases for recent decade. The keywords were “denosumab-related osteonecrosis of the jaw, denosumab, osteonecrosis of the jaw, osteoclast, RANKL/RANK, bisphosphonate-related osteonecrosis of the jaw” in English and Chinese, respectively. Fifty-four eligible articles were finally reviewed.
RESULTS AND CONCLUSION: As a new drug for osteoporosis, denosumab has a good clinical application prospect. The study of denosumab-related osteonecrosis of the jaw is still in the exploratory stage. The underlying mechanism of denosumab-related osteonecrosis of the jaw may be related to abnormal bone metabolism and immune dysfunction. Prevention is the main treatment for osteonecrosis of the jaw. Although conservative treatment is still the mainstream of treatment, surgery has greater chance to cure the disease. During treatment, discontinuing the drug and reducing the stimulus has positive effect. In the course of clinical drug use, we should strictly control the risk-benefit relationship, and communicate with patients about the advantages and disadvantages of treatment, so as to make the application of denosumab more reasonable, safe and effective.

Key words: denosumab, osteonecrosis of the jaw, osteoclast, bisphosphonate, osteoporosis, RANKL, RANK

CLC Number:

Wang Le, Zhang Xiaoming, Liu Tongbin. Denosumab-related osteonecrosis of the jaw: thinking from the direction of osteoclast targeted therapy[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(27): 4408-4413.

Figures/Tables 2

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