Pharmacogenomics in medication-related osteonecrosis of the jaw: a systematic literature review.

OBJECTIVE: Medication-related osteonecrosis of the jaw (ONJ) is an adverse, severe and debilitating effect, which although infrequent, affects patients with osteoporosis or neoplasm who take bisphosphonates, antiresorptive drugs, and/or antiangiogenic drugs. Its etiopathogenesis is unknown, although genetic causes have been postulated. MATERIALS AND METHODS: This review analyzed articles published to date that have studied genetic factors associated with ONJ. Fifteen case-control studies were included, published between 2008 and 2018. RESULTS: Five set out to determine genetic causes by means of genome-centered techniques, while ten do so by investigating gene-centered variants. Nine works found statistically significant associations between one or various single nucleotide polymorphisms (SNPs) and the appearance of ONJ. None of the studies coincided as to which genes present some association. CONCLUSIONS: The review observed the moderate impact of genetic factors on the appearance of ONJ. It also showed the heterogeneity of the studies that have investigated ONJ to date. In future studies, involving international and interhospital collaboration will be necessary to recruit sample sizes of sufficient size, elaborate adequate study designs, obtain clear results, and advance our understanding of ONJ and make it possible to single out individual patients at risk.

Resolution of a case of denosumab-related osteonecrosis of the jaw after tooth extraction.

Denosumab is an antiresorptive drug that blocks osteoclast maturation, function and survival, improving bone mineral density and reducing the probability of fracture. It has adverse effects and can be the cause of hypocalcemia and osteonecrosis of the jaw. This report describes the case of a 59-year-old woman with hypothyroidism, antecedents of breast cancer, two strokes, and severe bone osteoporosis. Extraction of tooth 3.6 was performed, and within a month she was administered with a denosumab injection. One month later maxillary osteonecrosis appeared in the lingual distal area of the extraction site. Four months later the case was resolved by means of non-surgical treatment.