Single low-dose of denosumab as a triggering agent for MRONJ development in a patient with osteoporosis Case report and mini-review

Abstract Both denosumab (DNO) and bisphosphonates (BP), antiresorptive drugs (ARDs) used for the treatment of osteoporosis and oncological disorders, are known for their potential to cause medication-related osteonecrosis of the jaws (MRONJ). Besides ARDs, statins were recently associated with MRONJ development, especially in patients taking higher doses of statins for a longer period of time. Here, we report a case of a woman with osteoporosis who rapidly developed MRONJ stage III after only a single low dose of DNO. The patient was taking statins (rosuvastatin) for 7 years and had also been on BP (alendronate) for 4 years previously but this treatment was discontinued for approximately 1.5 years before MRONJ development. We performed a literature review of cases with MRONJ triggered by a single low dose of DNO and of cases with statin-induced MRONJ in patients not using ARD. Because the MRONJ development after a single low dose of DNO is rare, only eleven cases were previously described. We suggest that (i) in some patients, long-term use of statins and BP may lead to a higher susceptibility of MRONJ development after DNO exposure and (ii) that all predisposing factors to MRONJ development including the necessity of any dental procedures should be considered before DNO therapy is initiated.