Abstract
Denosumab is a bone antiresorptive agent for use in patients with osteoporosis or metastatic cancer of the bones. A recent meta-analysis revealed that denosumab is associated with an increased risk of developing medication-related osteonecrosis of the jaw (MRONJ) compared with bisphosphonate (BP) treatment or placebo, although the increased risk was not statistically significant between denosumab and BP treatments. This paper presents the case of an 83-year-old man with MRONJ in the left maxilla caused by the use of denosumab for prostate cancer with multiple metastases to lymph nodes, bone and lungs, which improved by minimally invasive treatment after withdrawal of denosumab. The patient was given a subcutaneous injection of denosumab every 4 weeks for a period of 17 months. He had no history of receiving bisphosphonates or radiation therapy. We performed careful examinations and treatment with antibiotics, local irrigation and removal of as many necrotic bone chips as possible every 2 weeks. Finally, the remaining sequestrum was removed 10 months after the cessation of denosumab. The affected area was epithelialized within 19 days.
