Temporary Denosumab discontinuation promotes bone healing of Osteonecrosis of the jaw and minimizes the invasiveness of surgery: a case presentation

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 bone remodeling process, suggesting that denosumab-related osteonecrosis is a self-limiting disease, with high curative potential of surgery when performed after a proper time of RANKL-inhibitor suspension. We report the long-term clinical and radiological (CT scan) data of a patient affected by secondary osteoporosis (CTIBL for metastatic breast cancer) who under-went surgical treatment for stage II denosumab-related osteonecrosis of the upper maxilla 7-month after denosumab suspension. A minimally invasive approach was performed whit ex-traction of the first right upper molar and debridement of the surrounding alveolar bone. After surgery, patient was followed-up at three-month intervals up to 1 year and clinical and radiologi-cal data (CT scan) were recorded at each follow-up for early detection of signs of recurrent disease. Mucosal healing maintained stable in the long-term with radiological signs of bone remodeling in the post-operative site since the 6-month follow-up. The case presented strengthens the hypothesis that denosumab induces temporary alterations of bone turnover with predictable curative effect of minimal surgical procedures in cases of denosumab-related osteonecrosis of the jaw.