A Comparison of the Clinical and Radiological Extent of Denosumab (Xgeva(R)) Related Osteonecrosis of the Jaw: A Retrospective Study

Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive medication. The aim of this study was to evaluate the incidence of denosumab-related osteonecrosis of the jaw and to compare the clinical and radiological extent of osteonecrosis. A retrospective study of patients who received Xgeva(R) at the Institut de Cancerologie de Lorraine (ICL) was performed. Patients for whom clinical and radiological (CBCT) data were available were divided into two groups: exposed for patients with bone exposure and fistula when only a fistula through which the bone could be probed was observed. The difference between clinical and radiological extent was assessed. The p-value was set at 0.05, and a total of 246 patients were included. The cumulative incidence of osteonecrosis was 0.9% at 6 months, 7% at 12 months, and 15% from 24 months. The clinical extent of MRONJ was significantly less than their radiological extent: in the exposed group, 17 areas (45%) were less extensive clinically than radiologically (p < 0.001) and respectively 6 (67%) for the fistula group (p < 0.031). It would seem that a CBCT is essential to know the real extent of MRONJ. Thus, it would seem interesting to systematically perform a CBCT during the diagnosis of MRONJ, exploring the entire affected dental arch.

Automated summary

This study evaluated the incidence of denosumab-related osteonecrosis of the jaw and found that the clinical extent of MRONJ was significantly less than their radiological extent. It is recommended to perform a CBCT during the diagnosis of MRONJ to explore the entire affected dental arch.