title: Stage 0 osteonecrosis of the jaw in a patient on denosumab.
abstract: Osteonecrosis of the jaws (ONJ) is a complex disease involving multiple tissue and cell-type responses to wound healing or infection. AAOMS defines bisphosphonate related ONJ (BRONJ) as exposed, necrotic bone in the maxillofacial region that has persisted for more than 8 weeks in a patient with current or previous antiresorptive treatment, without a history of radiation therapy to the jaws. Since the first reported ONJ cases in 2003 and 2004, there has been little advancement in understanding the etiology and pathophysiology of ONJ. Many hypotheses have been proposed, including bisphosphonate (BP) toxicity to oral epithelium, altered wound healing after tooth extraction, high turnover of the mandible and maxilla, oral biofilm formation, infection and inflammation, and suppression of angiogenesis and bone turnover. The current classification system of ONJ involves stages 0 to 3 and is based on patient clinical presentation. This report describes a case of stage 0 ONJ in a patient on denosumab and indicates the full-spectrum similarities between BP- and denosumab-associated ONJ clinically, radiographically, and histologically.
authors.affiliation: Associate Professor, Division of Diagnostic and Surgical Sciences, University of California-Los Angeles School of Dentistry, Los Angeles, CA. Electronic address: taghaloo@dentistry.ucla.edu.
authors.forename: Tara L
authors.initials: TL
authors.lastname: Aghaloo
authors.affiliation: Professor, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Dry
authors.affiliation: Assistant Professor, Division of Diagnostic and Surgical Sciences, University of California-Los Angeles School of Dentistry, Los Angeles, CA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Mallya
authors.affiliation: Professor, Division of Diagnostic and Surgical Sciences, University of California-Los Angeles School of Dentistry, Los Angeles, CA; Molecular Biology Institute, University of California-Los Angeles, Los Angeles, CA.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Tetradis
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000175:diagnosis; D054893:Cone-Beam Computed Tomography / Q000379:methods; D000069448:Denosumab; D003937:Diagnosis, Differential; D005870:Giant Cell Tumors / Q000188:drug therapy; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000139:chemically induced*; D010020:Osteonecrosis / Q000139:chemically induced*; D053245:RANK Ligand / Q000037:antagonists & inhibitors*; D012447:Sacrum / Q000187:drug effects; D013125:Spinal Neoplasms / Q000188:drug therapy
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D053245:RANK Ligand; D000069448:Denosumab