Review of current literature and implications of RANKL inhibitors for oral health care providers.
Bisphosphonates (BPs) were the first class of drugs commonly used to prevent skeletal-related events (SRE) in patients with osteoporosis, multiple myeloma (MM), or solid tumors with metastases to bone. A new alternative class of agents, receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitors, are now available for use in these indications and have the potential to replace intravenous BPs. This paper presents a review of the current literature on denosumab and its association with osteonecrosis of the jaw (ONJ). Denosumab is a RANKL inhibitor that has recently been approved for the prevention of SRE for the same indications as BPs except for MM. Although the overall frequency of denosumab-related ONJ may be similar or higher than estimates of the occurrence rate of bisphosphonate-related ONJ, evidence continues to support appropriate planning and preventive care can reduce the likelihood of adverse effects, including osteonecrosis.
Oral and Maxillofacial Surgery Resident, St. Joseph's Regional Medical Center, Paterson, New Jersey. Electronic address: epsteinmatthew@gmail.com.
Matthew S
MS
Epstein
Hillel D
HD
Ephros
Joel B
JB
Epstein
D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000188:drug therapy; D000069448:Denosumab; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced*; D009101:Multiple Myeloma / Q000188:drug therapy; D010020:Osteonecrosis / Q000139:chemically induced*; D010024:Osteoporosis / Q000188:drug therapy; D053245:RANK Ligand / Q000037:antagonists & inhibitors*
D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D053245:RANK Ligand; D000069448:Denosumab