Management of Medication-Related Osteonecrosis of the Jaw in a Medically Compromised Patient: A Conservative Approach

Osteonecrosis of the jaw (ONJ) is a notable adverse effect linked to antiresorptive therapies used in the management of oncology and osteoporosis. This case study details a 71-year-old male patient who developed ONJ secondary to Denosumab treatment, administered as injections every four weeks over a year. The patient, evaluated at Birmingham Dental Hospital, presented with sequestration of the anterior maxilla (distal to the premolars). Notably, he had a prior history of radiotherapy in 2017 for follicular thyroid carcinoma with bony metastasis. The prevalence of ONJ among oncology patients receiving high-dose Denosumab is estimated between 1% and 15%¹. While the diagnosis of ONJ is predominantly clinical, the use of imaging modalities is essential for confirming the diagnosis and determining the extent of the disease. This case highlights the importance of vigilant monitoring, and taking a holistic approach in management of patients undergoing long-term antiresorptive therapy, especially those with additional cancer treatment histories.

1. Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O’Ryan F, Reid IR, Ruggiero SL, Taguchi A, Tetradis S, Watts NB, Brandi ML, Peters E, Guise T, Eastell R, Cheung AM, Morin SN, Masri B, Cooper C, Morgan SL, Obermayer-Pietsch B, Langdahl BL, Al Dabagh R, Davison KS, Kendler DL, Sándor GK, Josse RG, Bhandari M, El Rabbany M, Pierroz DD, Sulimani R, Saunders DP, Brown JP, Compston J; International Task Force on Osteonecrosis of the Jaw. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res. 2015 Jan;30(1):3-23. doi: 10.1002/jbmr.2405. PMID: 25414052.