BACKGROUND AND OBJECTIVES

Giant cell tumor of bone (GCTB) is a benign aggressive tumor primarily treated with surgery. Neoadjuvant treatment with denosumab or zoledronic acid is a common adjunct given to down-stage tumors and facilitate limb sparing surgery. This study sought to determine the characteristics, outcomes, and occurrence of complications following resection (RS) or extended curettage (EC) for GCTB of the lower extremities. Correlation of neoadjuvant therapy with the occurrence of complications was also investigated.

This is an analytical cross-sectional study of 30 patients diagnosed with GCTB of the lower extremity treated between 2015 to 2022 in a single tertiary hospital. Functional outcomes were determined using the 1993 version of the Musculoskeletal Tumor Society (MSTS) score. Mean follow-up for all patients was 2.6 years (SD 1.8). Twenty-two patients (73%) underwent resection, while eight (27%) patients underwent extended curettage. Of the 30 patients, 26 (87%) patients received neoadjuvant therapy, with 21 (81%) given denosumab and five (19%) given zoledronic acid.

Functional outcomes were excellent for 23 patients (77%), with no significant difference between RS and EC groups. Nine complications occurred in the RS group, including dehiscence (n=3), superficial infection (n=2), implant failure (n=1), nonunion (n=1), palsy (n=1), and implant irritation (n=1). Five complications occurred in the EC group, four of which were noted to be recurrences, with one case of deep infection. Recurrence was noted to be significantly higher (p=0.0004) in the EC group. Separate correlation analysis showed no significant difference in incidence of complications but found that duration of surgery was significantly longer (p=0.0001), and intraoperative blood loss was significantly higher (p=0.0072) in the RS group. No significant difference (p=0.78) was noted in complication rate between patients given denosumab versus zoledronic acid.

Functional outcomes of EC and RS appear to be comparable, including the incidence of complications. However, recurrence was noted to be significantly higher in EC. There appears to be no clear advantage between denosumab or zoledronic acid for GCTB. As a neoadjuvant medication and/or to control tumor progression, zoledronic acid may be the more economic option especially for patients in developing countries.

OBJECTIVE: To evaluate the effect of denosumab on bone mineral density around proximal femoral prosthesis after total hip arthroplasty(THA) in the postmenopausal osteoporotic patients. METHODS: Fifty-four consecutive patients underwent unilateral primary THA were included in this retrospective study. Twenty-five patients received denosumab for osteoporosis as the treatment group, and the twenty-nine without denosumab were the control group. At 1 week, 3month, 6 months, and 12 months after THA, bone turnover markers and proximal femoral periprosthetic bone mineral density (BMD) were measured. RESULTS: At 3, 6 and 12 months after operation, the level of TRACP-5b in the control group was significantly higher than that in the treatment group (P<0.05);the level of bone-specific alkaline phosphatase (BALP) between two groups showed significant difference in 12 months after operation (control group was higher than treatment group, P<0.05). The BMD of Gruen 1 and Gruen 7 decreased at 3, 6 and 12 months after operation compared with 1 week after operation. Comparing the treatment group and the control group, the differences of the the decrease of BMD in Gruen 1 and Gruen 7 were no significant at 3 months after surgery. In Gruen 1, Gruen 7 at 6 months after operation and Gruen 1, Gruen 7 at 12 months after operation, the decrease of BMD in the control group was significantly higher than that in the treatment group(P<0.05). It is suggested that desudumab could inhibit the loss of BMD after 6 months, and continuously show a protective effect on bone mass at 12 months after operation. CONCLUSION After THA in postmenopausal patients with osteoporotic femoral neck fracture, Desuzumab can reduce the loss of BMD around the proximal femoral prosthesis and effectively inhibit bone resorption.
Humans ; Arthroplasty, Replacement, Hip ; Bone Density ; Denosumab/therapeutic use* ; Retrospective Studies ; Postmenopause ; Absorptiometry, Photon ; Bone Remodeling ; Follow-Up Studies ; Hip Prosthesis

Antiresorptive drugs (ARDs), such as bisphosphonates or denosumab, that prevent bone resorption are widely used in patients with osteoporosis or with cancer that has metastasized to the bones. Although osteonecrosis of the jaw (ONJ) is a well-documented complication of ARD use, the benefits ARDs outweigh the complication. Thus, research has focused on finding ways to prevent or reduce the risk of developing ONJ. Dentists, as part of a multi-professional team, have a critical role in preventing ONJ. However, many dentists tend to hesitate to provide dental care to patients with ONJ, or tend to think that it is a problem to be dealt with by oral surgeons. This review gives an overview of ARD-related ONJ and provides the guidelines for dental care in patients taking ARDs to lower the risk of developing ONJ.
Bone Density Conservation Agents ; Bone Resorption ; Denosumab ; Dental Care ; Dentists ; Diphosphonates ; Humans ; Jaw ; Oral and Maxillofacial Surgeons ; Osteonecrosis ; Osteoporosis

BACKGROUND: Giant-cell tumor of bone (GCTB) is a locally aggressive primary benign tumor presenting as an expansile osteolytic lesion affecting the epiphysis of long bones. Denosumab halts the osteolysis by giant cells thereby downstaging the tumor, helping in performing less morbid procedures to remove the tumor. Our aim was to report the incidence of local recurrence (LR) in patients operated following neoadjuvant denosumab, to investigate factors associated with LR following extended curettage for GCTB, and to compare the postoperative functional and oncological outcome of patients operated with and without neoadjuvant denosumab. METHODS: A total of 123 patients with a mean age of 29.6 years undergoing extended curettage for GCTB were retrospectively divided into group 1 receiving neoadjuvant denosumab and group 2 operated without denosumab. The mean follow-up period was 35 months. The perioperative characteristics and outcome were compared between the two groups and the factors for LR of GCTB were analyzed. RESULTS: The incidence of LR among patients operated after neoadjuvant denosumab therapy was 42.8% and was significantly high compared to that in patients without denosumab (p < 0.001). On multivariate logistic regression analysis, use of denosumab as a neoadjuvant was the only factor independently associated with LR following surgery (p = 0.002). Patients treated with denosumab had a lower LR-free survival rate (log-rank, p = 0.018). CONCLUSIONS: Denosumab was independently associated with increased LR following surgery for GCTB. Denosumab has to be used cautiously in patients in whom the burden of downstaging the disease outweighs the possible chance of LR.
Curettage ; Denosumab ; Epiphyses ; Follow-Up Studies ; Giant Cell Tumors ; Giant Cells ; Humans ; Incidence ; Logistic Models ; Osteolysis ; Recurrence ; Retrospective Studies ; Survival Rate

Osteonecrosis of the jaw (ONJ) is a well-known pathological condition in oncology derived from the use of bisphosphonates (BPs) and denosumab. Many molecular and immunological targets have been introduced for daily use in cancer treatment in recent years; consequently, new cases of ONJ have been reported in association with these drugs, especially if administered with BPs and denosumab. When the drugs are administered alone, ONJ is rarely seen. The objective of our study was to analyze the recent literature relative to the association of ONJ with these new drugs highlighting the pathogenic, clinical and therapeutic aspects. The close collaboration between maxillofacial surgeon, oncologist, dentist, and dental hygienist remains the most important aspect for the prevention, prompt recognition, and treatment of this pathology.
Angiogenesis Modulating Agents ; Cooperative Behavior ; Denosumab ; Dental Hygienists ; Dentists ; Diphosphonates ; Humans ; Immunomodulation ; Immunotherapy ; Jaw ; Oral and Maxillofacial Surgeons ; Oral Manifestations ; Osteonecrosis ; Pathology

Osteoporosis is a skeletal disorder characterized by compromised bone strength resulting in a predisposition to fracture. Osteoporosis-related fractures can lead to pain, disability, and increased healthcare costs. This study aimed to explore different pharmacological treatments for osteoporosis. Various treatments are used to prevent and treat osteoporosis, particularly in postmenopausal women and elderly men, but the approach needs to be individually tailored. Bisphosphonates are most commonly used to treat osteoporosis. Bisphosphonates and denosumab are mainly used during the initial phase of therapy for most patients with osteoporosis, including those with a high risk of fracture. In younger postmenopausal women, menopausal hormone therapy (including tibolone) and selective estrogen receptor modulators may be considered as alternatives for fracture prevention. Parathyroid hormone therapy is recommended for osteoporosis treatment in elderly patients with an increased risk of multiple vertebral fractures. Dual energy X-ray absorptiometry (DXA) is the mainstay for monitoring the treatment response, and clinicians may consider alternative treatments if a significant decrease in bone mineral density is detected (using DXA or bone turnover markers) or if recurrent fractures occur during treatment. For postmenopausal women undergoing long-term bisphosphonate treatment, the risk of fracture should be reassessed after 3 to 5 years, and a “drug holiday” should be considered if the risk of fracture is low-to-moderate. Therapy should be continued for patients who continue to exhibit a high risk of fracture, or alternatively, switching to other treatments may be considered.
Absorptiometry, Photon ; Aged ; Bone Density ; Bone Remodeling ; Denosumab ; Diphosphonates ; Drug Therapy ; Female ; Health Care Costs ; Humans ; Male ; Osteoporosis ; Parathyroid Hormone ; Selective Estrogen Receptor Modulators

Alkaline Phosphatase ; metabolism ; Asian Continental Ancestry Group ; Bone Density Conservation Agents ; therapeutic use ; China ; Denosumab ; therapeutic use ; Diabetes Mellitus, Type 2 ; complications ; Female ; Humans ; Hyperlipidemias ; complications ; Hypertension ; complications ; Middle Aged ; Osteitis Deformans ; complications ; diagnostic imaging ; drug therapy ; metabolism ; Pelvic Bones ; diagnostic imaging ; Renal Insufficiency, Chronic ; complications ; Singapore ; Tibia ; diagnostic imaging ; Treatment Outcome

Osteoporosis is a major, growing healthcare issue. This is especially of concern in an ageing population like that of Singapore. Osteoporotic patients are at risk of fractures, which can result in increased morbidity and mortality. The use of antiresorptive therapy with bisphosphonates or denosumab has been proven to reduce fracture risk. However, the use of these medications has rarely been associated with the development of osteonecrosis of the jaw, a potentially debilitating condition affecting one or both jaws. Appropriate understanding of the patient's antiresorptive therapy regime, as well as early institution of preventive dental measures, can play an important role in preventing medication-related osteonecrosis of the jaw (MRONJ). Regular monitoring and prompt referral to specialist care is warranted for patients with established MRONJ.
Aged ; Bone Density Conservation Agents ; adverse effects ; therapeutic use ; Denosumab ; adverse effects ; therapeutic use ; Diphosphonates ; adverse effects ; therapeutic use ; Humans ; Jaw Diseases ; chemically induced ; prevention & control ; Osteonecrosis ; chemically induced ; prevention & control ; Osteoporosis ; complications ; drug therapy ; Osteoporotic Fractures ; complications ; drug therapy ; Risk Factors ; Singapore ; Treatment Outcome

Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication of bisphosphonates (BPs) or other targeted agent therapies. MRONJ appears as exposed bone, pus, and swelling in the oral and maxillofacial regions. However, neither surgery nor conservative therapy can eliminate symptoms thoroughly. In addition to BPs, several antiresorptive and antiangiogenic agents, such as denosumab and bevacizumab, as well as targeted agents, such as sunitinib and temsirolimus, can cause osteonecrosis of  the  jaw according to the literature. This review aims to summarize the research progress on these new drugs.
Angiogenesis Inhibitors ; therapeutic use ; Bisphosphonate-Associated Osteonecrosis of the Jaw ; drug therapy ; Bone Density Conservation Agents ; adverse effects ; Denosumab ; therapeutic use ; Diphosphonates ; Humans

Giant cell tumors(GCT) of bone is benign bone tumors with aggressive and osteolytic activity. As traditional treatment of GCT, removal of bone graft is disease with high local recurrence rate, and could reduce local recurrence by auxiliary means. Different surgical methods such as prosthesis replacement, wide resection and En-bloc resection could be selected for different parts of giant cell tumor of bone, based on the lesion location, size, extent of invasion, recurrence rate. For patients with special region of GCT of bone with removed incompletely and high surgical risk expected, arterial embolism could be performed. The application of bisphosphonates and denosumab are mainly used in treating recurrent, refractory, special parts, metastatic giant cell tumor of bone will bring new hope of treatment for giant cell tumor of bone, due to lower the recurrence rate. Chemotherapy is mainly used in the treatment of metastasis and malignant bone tumor. Radiotherapy for recurrent or unresectable bone giant cell tumor can control tumor progression, but there is the possibility of malignancy. While long-term follow-up studies and long-term results of applications of bisphosphonates and denosumab are lacking, new methods and development of new drugs are still be needed to treat patients with giant cell tumor of bone and also bring about more hope.
Bone Neoplasms ; drug therapy ; surgery ; Denosumab ; therapeutic use ; Diphosphonates ; therapeutic use ; Giant Cell Tumor of Bone ; drug therapy ; surgery ; Humans ; Neoplasm Recurrence, Local ; Treatment Outcome