{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T04:52:32Z","timestamp":1778043152126,"version":"3.51.4"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T00:00:00Z","timestamp":1625788800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T00:00:00Z","timestamp":1625788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003407","name":"Ministero dell\u2019Istruzione, dell\u2019Universit\u00e0 e della Ricerca","doi-asserted-by":"crossref","award":["PON-AIM Line 1 - Id. AIM1892002"],"award-info":[{"award-number":["PON-AIM Line 1 - Id. AIM1892002"]}],"id":[{"id":"10.13039\/501100003407","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Head Face Med"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec>\n                <jats:title>Abstract<\/jats:title>\n                <jats:p>Denosumab is associated with the development of medication-related osteonecrosis of the jaw (MRONJ), an uncommon but severe oral side effect with a higher prevalence in metastatic cancer patients than in patients with metabolic bone fragility. Although several oral triggers can initiate MRONJ, invasive oral treatments and tooth extraction still remain the most common precipitating event. In general, tooth extraction and oral surgery should be avoided in patients at increased risk of MRONJ, while extraction of non-restorable teeth should be performed based on specific risk reduction protocols to eliminate dental\/periodontal infections, still protecting from MRONJ onset.<\/jats:p>\n                <jats:p>Based on the different pharmacological activity of denosumab and nitrogen-containing bisphosphonates, it is likely that the MRONJ risk profile of patients with osteoporosis could somewhat vary.<\/jats:p>\n                <jats:p>We hypothesize the chance to maximize the pharmacokinetic of denosumab 60\u2009mg (Prolia\u00ae) and identify a time interval in which invasive oral treatments can ideally take place without restrictions in patients with metabolic bone fragility,<\/jats:p>\n                <jats:p>We propose that dental surgery (e.g. tooth extraction) may be safely performed without additional intra or peri-operative procedures in osteoporosis patients using denosumab provided that careful case selection, adequate communication among specialists, planning of a delayed dosing window (1-month deferral) and rigorous postoperative follow-up are granted.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Graphical abstract<\/jats:title>\n                \n              <\/jats:sec>","DOI":"10.1186\/s13005-021-00280-4","type":"journal-article","created":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T04:03:31Z","timestamp":1625803411000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["A pragmatic window of opportunity to minimise the risk of MRONJ development in individuals with osteoporosis on Denosumab therapy: a hypothesis"],"prefix":"10.1186","volume":"17","author":[{"given":"Giuseppina","family":"Campisi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4008-6502","authenticated-orcid":false,"given":"Rodolfo","family":"Mauceri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Bertoldo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vittorio","family":"Fusco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Bedogni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,7,9]]},"reference":[{"key":"280_CR1","doi-asserted-by":"publisher","DOI":"10.32388\/594095","volume-title":"Medication related osteonecrosis of the jaw (MRONJ)","author":"A Bedogni","year":"2018","unstructured":"Bedogni A, Campisi G, Fusco V. Medication related osteonecrosis of the jaw (MRONJ). London: Qeios; 2018. https:\/\/doi.org\/10.32388\/594095."},{"issue":"2","key":"280_CR2","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.oooo.2018.09.008","volume":"127","author":"O Nicolatou-Galitis","year":"2019","unstructured":"Nicolatou-Galitis O, Schi\u00f8dt M, Mendes RA, Ripamonti C, Hope S, Drudge-Coates L, et al. Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019;127(2):117\u201335. https:\/\/doi.org\/10.1016\/j.oooo.2018.09.008.","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol"},{"issue":"10","key":"280_CR3","doi-asserted-by":"publisher","first-page":"1938","DOI":"10.1016\/j.joms.2014.04.031","volume":"72","author":"SL Ruggiero","year":"2014","unstructured":"Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, et al. American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw - 2014 update. J Oral Maxillofac Surg. 2014;72(10):1938\u201356. https:\/\/doi.org\/10.1016\/j.joms.2014.04.031.","journal-title":"J Oral Maxillofac Surg"},{"issue":"2","key":"280_CR4","doi-asserted-by":"publisher","first-page":"257","DOI":"10.2217\/fon.13.211","volume":"10","author":"G Campisi","year":"2014","unstructured":"Campisi G, Fedele S, Fusco V, Pizzo G, Di Fede O, Bedogni A. Epidemiology, clinical manifestations, risk reduction and treatment strategies of jaw osteonecrosis in cancer patients exposed to antiresorptive agents. Future Oncol. 2014;10(2):257\u201375. https:\/\/doi.org\/10.2217\/fon.13.211.","journal-title":"Future Oncol"},{"issue":"7","key":"280_CR5","doi-asserted-by":"publisher","first-page":"1815","DOI":"10.1111\/odi.13160","volume":"25","author":"M Schiodt","year":"2019","unstructured":"Schiodt M, Otto S, Fedele S, Bedogni A, Nicolatou-Galitis O, Guggenberger R, et al. Workshop of European task force on medication-related osteonecrosis of the jaw\u2014current challenges. Oral Dis. 2019;25(7):1815\u201321. https:\/\/doi.org\/10.1111\/odi.13160.","journal-title":"Oral Dis"},{"key":"280_CR6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2018\/2684924","volume":"2018","author":"O Di Fede","year":"2018","unstructured":"Di Fede O, Panzarella V, Mauceri R, Fusco V, Bedogni A, Lo Muzio L, et al. The dental management of patients at risk of medication-related osteonecrosis of the jaw: new paradigm of primary prevention. Biomed Res Int. 2018;2018:1\u201310. https:\/\/doi.org\/10.1155\/2018\/2684924.","journal-title":"Biomed Res Int"},{"issue":"6","key":"280_CR7","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1016\/j.jcms.2015.03.039","volume":"43","author":"S Otto","year":"2015","unstructured":"Otto S, Troltzsch M, Jambrovic V, Panya S, Probst F, Ristow O, et al. Tooth extraction in patients receiving oral or intravenous bisphosphonate administration: a trigger for BRONJ development? J Cranio Maxillofacial Surg. 2015;43(6):847\u201354. https:\/\/doi.org\/10.1016\/j.jcms.2015.03.039.","journal-title":"J Cranio Maxillofacial Surg"},{"issue":"5","key":"280_CR8","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1007\/s00198-017-3919-1","volume":"28","author":"MR McClung","year":"2017","unstructured":"McClung MR, Wagman RB, Miller PD, Wang A, Lewiecki EM. Observations following discontinuation of long-term denosumab therapy. 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