Medication-related osteonecrosis of the jaw associated with bisphosphonates and denosumab in osteoporosis

Oral Dis. 2016 May;22(4):324-9. doi: 10.1111/odi.12447. Epub 2016 Feb 26.


Objective: To describe the clinical characteristics and evolution of our series of medication-related osteonecrosis of the jaws (MRONJ) associated with denosumab in osteoporotic patients.

Material and methods: We present 10 new cases of MRONJ in patients receiving denosumab for osteoporosis. We describe the mean doses of denosumab, previous bisphosphonate intake, and the clinical characteristics associated with the osteonecrosis, such as local contributing factors, symptoms, and evolution after treatment.

Results: The mean number of denosumab doses was 3.4 ± 2.2. In 90% of patients, there was a prior history of oral bisphosphonate intake, with a mean duration of 46.78 ± 25.11 months. The most common local factor was dental extraction (6 cases; 60%), and most cases had necrotic bone exposure (9/10, 90%). Sclerosis of the bone was the most common radiographic finding. Stage 1 was the most common ONM stage, found in 80%. 'Cure' after conservative treatments was obtained in 71.4%.

Conclusions: Most of our cases were in the early stages of MRONJ, and the success rate after conservative treatment was high.

Keywords: denosumab; jaw; osteonecrosis; osteoporosis.

MeSH terms

  • Aged
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / diagnostic imaging
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / etiology*
  • Bone Density Conservation Agents / adverse effects*
  • Denosumab / adverse effects*
  • Diphosphonates / adverse effects
  • Female
  • Humans
  • Male
  • Middle Aged
  • Osteoporosis / drug therapy
  • Sclerosis
  • Tomography, X-Ray Computed


  • Bone Density Conservation Agents
  • Diphosphonates
  • Denosumab