Denosumab Therapy in Dental Practice: Awareness, Risk Factors and Preventive Strategies.

Area of Science:

• Oral and Maxillofacial Surgery
• Pharmacology
• Oncology

Background:

• Denosumab is widely used for osteoporosis and metastatic bone disease.
• Medication-related osteonecrosis of the jaw (MRONJ) is an emerging complication associated with denosumab therapy.
• Denosumab-associated MRONJ presents unique challenges compared to bisphosphonate-induced MRONJ.

Purpose of the Study:

• To review current knowledge on denosumab-associated MRONJ.
• To examine epidemiology, pathophysiology, clinical features, risk factors, and prevention strategies.
• To provide practical recommendations and a decision-making flowchart for dental practitioners.

Main Methods:

• Narrative review of existing literature on denosumab-associated MRONJ.
• Synthesis of guidelines and research findings.
• Development of a clinical decision-making flowchart.

Main Results:

• Denosumab-associated MRONJ has distinct characteristics requiring specific management.
• Early dental assessment and oral health optimization before denosumab initiation are vital.
• Coordinated dental interventions around denosumab dosing, utilizing "windows of opportunity," may improve safety.

Conclusions:

• Understanding denosumab-associated MRONJ is essential for reducing patient morbidity.
• Enhanced collaboration between medical prescribers and dental practitioners is key.
• Early identification and proactive management are crucial for preventing adverse outcomes.