Turkiye Klinikleri Journal of Dental Sciences

.: CASE REPORTS
Denosumab-Related Osteonecrosis of the Jaw with Actinomycosis Infection and Extensive Periosteal Reaction
Aktinomikoz Enfeksiyonu ve Yaygın Periost Reaksiyonu Gösteren Denosumab İlişkili Çene Kemiği Osteonekrozu
Elif ASLANa , Gözde IŞIKb , Elif ŞENERa , Başak DOĞANAVŞARGİLc , Banu ÖZVERİ KOYUNCUb , Hülya ÇANKAYAa
aEge University Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, İzmir, Türkiye
bEge University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, İzmir, Türkiye
cEge University Faculty of Medicine, Department of Pathology, İzmir, Türkiye
Turkiye Klinikleri J Dental Sci. 2024;30(2):346-51
doi: 10.5336/dentalsci.2023-99691
Article Language: EN
Full Text
ABSTRACT
 Medication-related osteonecrosis of the jaws (MRONJ) is a well-known side effect of bisphosphonate drugs used in the treatment of osteometabolic disorders and some types of cancer. However, development of MRONJ have also been reported in patients using denosumab, a monoclonal immunoglobulin G2 antibody inhibiting osteoclastic bone resorption. Even though denosumab is more advantageous than bisphosphonates due to its shorter half-life and lack of binding to the bone, MRONJ has accepted as a well-known side-effect of denosumab as it is in bisphosphonates. We reported clinical, radiographic, and histopathological findings of a female patient who developed osteonecrosis of the jaw following denosumab treatment and presented with actinomycosis infection and extensive periosteal new bone formation. Our case emphasized the importance of dental screening before initiating and during denosumab treatment in order to prevent and lower the risk of MRONJ development.

Keywords: Actinomyces; actinomycosis; denosumab; mandible; osteonecrosis
ÖZET
 İlaca bağlı çene kemiği osteonekrozu [medication-related osteonecrosis of the jaws (MRONJ)], metabolik kemik hastalıklarının ve bazı kanser tiplerinin tedavisinde kullanılan bisfosfonat grubu ilaçların bilinen bir yan etkisidir. Bununla birlikte osteoklastik kemik rezorpsiyonunu inhibe eden bir monoklonal immünglobulin G2 antikoru olan denosumab kullanan hastalarda da MRONJ gelişimi bildirilmiştir. Denosumab, yarılanma ömrünün daha kısa olması ve kemiğe bağlanmaması nedeniyle bifosfonatlara göre daha avantajlı olsa da günümüzde MRONJ bifosfonat grubu ilaçların yanı sıra denosumabın da bilinen bir yan etkisi olarak kabul görmektedir. Bu olgu raporunda, denosumab tedavisini takiben çene osteonekrozu gelişen ve aktinomikoz enfeksiyonu ile yaygın periosteal yeni kemik oluşumu saptanan bir kadın hastanın klinik, radyografik ve histopatolojik bulguları sunulmaktadır. Olgumuz, MRONJ gelişimini önlemek ve MRONJ gelişim riskini azaltmak amacıyla denosumab tedavisine başlamadan önce ve tedavi sırasında yapılması gereken dental muayenenin önemini vurgulamaktadır.

Anahtar Kelimeler: Aktinomiçes; aktinomikoz; denosumab; mandibula; osteonekroz
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