Differences between bisphosphonate-related and denosumab-related osteonecrosis of the jaws: a systematic review

• Published in: Supportive care in cancer Vol. 29; no. 6; pp. 2811 - 2820
• Main Authors: Querrer, Raiza, Ferrare, Nathália, Melo, Nilce, Stefani, Cristine Miron, dos Reis, Paula Elaine Diniz, Mesquita, Carla Ruffeil Moreira, Borges, Gabriel Alvares, Leite, André Ferreira, Figueiredo, Paulo Tadeu
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2021; Springer; Springer Nature B.V
• Subjects: Antibodies; Bisphosphonate-Associated Osteonecrosis of the Jaw - drug therapy; Bisphosphonates; Bone Density Conservation Agents - pharmacology; Bone Density Conservation Agents - therapeutic use; Bones; Cross-Sectional Studies; Denosumab; Denosumab - adverse effects; Density; Diphosphonates - adverse effects; Gangrene; Humans; Immunotherapy; Jaw; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Monoclonal antibodies; Necrosis; Nursing; Nursing Research; Oncology; Pain Medicine; Rehabilitation Medicine; Review Article; Side effects; Systematic review; Osteonecrosis; Review; Denosumab; Bisphosphonates
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-020-05855-6

Objective Bisphosphonates and denosumab are both antiresorptive medications, each with their own mechanism of action; yet both may result in the same adverse effect: medication-related osteonecrosis of the jaw (ONJ). The present systematic review aims to answer the following question: “Are bisphosphonate-related ONJ and denosumab-related ONJ any different, regarding clinical and imaging aspects?” Methods This review followed the Joanna Briggs Review’s Manual, and the searches were performed on PubMed, Cochrane, Scopus, Web of Science, and Lilacs databases and on the grey literature (ProQuest, Open Grey, and Google Scholar). Results The searches resulted in 7535 articles that were critically assessed. Based on the selection criteria, seven studies were included in the review: five cross-sectional studies and two randomized clinical trials. A total of 7755 patients composed the final population. An increase in bone sequestra, cortical bone lysis, and bone density was observed in bisphosphonate-related ONJ, while larger bone sequestra, more frequent periosteal reactions, and mandibular canal enhancement were noted in denosumab-related ONJ. Conclusion This systematic review demonstrated that the imaging characteristics of bisphosphonate-related and denosumab-related ONJ are not similar. Although clinically similar conditions, they were found to be radiographically distinct. More studies are necessary to further elucidate these differences.