A case of osteonecrosis of the mandible related to denosumab

Anti-resortive agents including Bisphosphonate (BP) are widely used in the management of metastatic bone disease and osteoporosis. Recently, there have been reports of osteonecrosis of the jaws as a complication of anti resortive agents-related osteonecrosis of the jaw (ARONJ). Denosmab is a monoclonal antibody against to receptor activator of nuclear factor k B ligand. A 75-year-old woman with osteoporosis, who had received denosumab from July 2016 through January 2017, presented with a swelling and purulent discharge from a fistula in the left submandibular region. Physical examination revealed ulceration over the left mandible and a devitalized bone exposed around the left mandibular canine. CT of the lesion revealed an extensive radiolucent area in the left and right sides of the mandible. ARONJ was diagnosed. Denosmap was discontinued, and surgical intervention was carried out followed by antibiotic therapy and oral care management. Complete recovery from the lesion was observed 4 months after initial treatment.