For Osteoporosis Awareness and Prevention Month, we are highlighting Denosumab, an alternative medication to bisphosphonates. Although osteonecrosis of the jaw (ONJ) is a well-known adverse effect of Denosumab, the FDA recently reported a new Black Box Warning. Keep on reading to find out more:
Generic Name: Denosumab
Brand Name(s): Prolia, Xgeva
Pronunciation: den OH sue mab
About this drug:
The Prolia brand is used to treat osteoporosis in women after menopause who are at high risk for a fracture or who cannot use or have had unsuccessful treatment with other osteoporosis medications.
The Xgeva brand is used to prevent bone fractures and other skeletal conditions in people with tumors that have spread to the bone.
Denosumab is indicated for increasing bone mass in men who are at high risk for fractures with osteoporosis or receiving certain treatments for prostate cancer that has not spread to other parts of the body.
This medication is also used to treat osteoporosis in men and women who will be taking steroid medications for at least six months and are at high risk for fracture.
Dentistry-related tidbits:
Advise patients to have regular exams and cleaning appointments to prevent periodontal infections.
A dental examination is recommended prior to treatment in patients with risk factors for osteonecrosis of the jaw (ONJ) such as periodontal infections, recent extractions, wearing removable appliances, invasive dental procedures, concomitant therapies (e.g. chemotherapy, corticosteroids, angiogenesis inhibitors), and poor oral hygiene.
Dentists should coordinate the dental treatment with the patient's physician. It is always best to complete the dental treatment before starting this medication.
Denosumab may cause ONJ after invasive dental procedures and may increase with the duration of exposure to this medication. Good oral hygiene practices should be maintained during treatment with Denosumab.
Aminoglycoside antibiotics such as Gentamicin and Tobramycin in combination with Denosumab may increase the risk of hypocalcemia. Before prescribing any medication, use the Rx Check tool to prevent potential drug interactions or adverse effects.
Fun facts:
Denosumab is a monoclonal antibody that binds to the receptor activator of nuclear factor kappa-B ligand (RANKL), inhibiting osteoclast formation which leads to less bone resorption and more bone mass.
As of January 2024, the FDA added a Black Box Warning regarding an increased risk of severe hypocalcemia in patients with advanced chronic kidney disease.
Patients should not smoke or drink alcohol as these may reduce bone density and make fractures occur more easily.
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