Denosumab-associated osteonecrosis of the jaw affects osteoclast formation and differentiation: Pathological features of two cases

Matsushita,Yuki; Hayashida,Saki; Morishita,Kota; Sakamoto,Hiroshi; Naruse,Tomofumi; Sakamoto,Yuki; Yamada,Shin‑Ichi; Yanamoto,Souichi; Fujita,Shuichi; Ikeda,Tohru; Umeda,Masahiro

doi:10.3892/mco.2015.696

Denosumab-associated osteonecrosis of the jaw affects osteoclast formation and differentiation: Pathological features of two cases

Authors:
- Yuki Matsushita
- Saki Hayashida
- Kota Morishita
- Hiroshi Sakamoto
- Tomofumi Naruse
- Yuki Sakamoto
- Shin‑Ichi Yamada
- Souichi Yanamoto
- Shuichi Fujita
- Tohru Ikeda
- Masahiro Umeda
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Affiliations: Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852‑8588, Japan, Department of Oral Pathology and Bone Metabolism, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852‑8588, Japan
Published online on: December 7, 2015 https://doi.org/10.3892/mco.2015.696
Pages: 191-194

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Abstract

Medication-related osteonecrosis of the jaw (ONJ) is caused by antiresorptive (bisphosphonates and denosumab) and antiangiogenic agents, with the first report of denosumab-related ONJ emerging in 2010. To date, although certain case reports on denosumab‑related ONJ have been published, those of ONJ caused by a single application of the drug are scarce. In addition, only one report described the histopathological features of this condition, although not completely; only the sequestrum resected by conservative surgery was evaluated. Although conservative treatment is recommended, the effectiveness of extensive surgery in the early stages of bisphosphonate‑related ONJ has been described in recent years. Here we report the clinical and histopathological features of denosumab‑related ONJ caused by single application of the drug, which was treated by extensive surgery in two patients. Histopathological analysis revealed a decreased number of osteoclasts in viable bone around the sequestrum, and these appeared morphologically immature, as indicated by the presence of very few nuclei. These findings are different from those for bisphosphonate‑related ONJ and may assist in elucidating the mechanism underlying denosumab‑related ONJ. Furthermore, extensive surgery may be effective for the management of this condition.

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