To the Editor: Khatri’s and Stuckey’s1 article, Vertebral fractures after denosumab discontinuation for dental procedures: a consequence of distorted perceptions of risk, sums up the authors’ knowledge and experience of medication‐related osteonecrosis of the jaws (MRONJ) in the latter part of the title. They quote the risk of MRONJ as being very low and equal for denosumab and oral bisphosphonates. This is incorrect. The risk of MRONJ is 0.3%.2 In our study we found the risk following extractions at 1.8%.3 The recent 2022 update of the position paper on MRONJ4 found that the risk with denosumab is an order of magnitude higher than for bisphosphonates.
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- 1. Khatri NS, Stuckey BGA. Vertebral fractures after denosumab discontinuation for dental procedures: a consequence of distorted perceptions of risk. Med J Aust 2022; 216: 283‐284. https://www.mja.com.au/journal/2022/216/6/vertebral‐fractures‐after‐denosumab‐discontinuation‐dental‐procedures
- 2. Bone HG, Wagman RB, Brandi ML, et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open‐label extension. Lancet Diabetes Endocrinol 2017; 5: 513‐523.
- 3. Colella A, Yu E, Bereza S, et al. The management of patients on denosumab for osteoporosis requiring dental extractions. A prospective single centre cohort‐controlled study. Poster ANZAOMS Hybrid Meeting; Melbourne (Australia), 16–17 Nov 2021.
- 4. Ruggierio SL, Dodson TB, Aghaloo T, et al. American Association of Oral and Maxillofacial Surgeons’ position paper on medication‐related osteonecrosis of the jaws — 2022 update. J Oral Maxillofac Surg 2022; 80: 920‐943.
- 5. Carlson ER. Management of antiresorptive osteonecrosis of the jaws with primary surgical resection. J Oral Maxillofac Surg 2014; 72: 655‐657.
- 6. Goss AN. Evidence‐based guidelines for patients on antiresorptive medications for osteoporosis requiring dental extractions. Australian Dental Association News Bulletin 2021; 515: 22‐24.
- 7. Ng TL, Tu MM, Ibrahim MFK, et al. Long‐term impact of bone‐modifying agents for the treatment of bone metastases: a systematic review. Support Care Cancer 2021; 29: 925‐943.
- 8. Smith S, Finn B, Goss AN. Medication‐related osteonecrosis of the jaws: a single centre, Far North Queensland case series. Aust Dent J 2022; https://doi.org/10.1111/adj.12905 [Epub ahead of print].
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