Rationale: Denosumab is a commonly used agent for the management of osteoporosis, particularly in elderly populations. The adverse reaction associated with its use is osteomyelitis of the jaw, which poses significant clinical challenges, especially in patients with compromised overall health. Patient concerns: The patient was an elderly individual with osteoporosis and a documented history of denosumab treatment. At the time of consultation, the primary manifestations included pain, swelling, and purulent discharge at the extraction socket, which impaired normal eating and quality of life. The patient urgently sought safe and effective treatment to alleviate discomfort and restore oral function. Diagnoses: Based on the patient’s clinical manifestations, history of denosumab treatment, imaging studies, and laboratory tests, the final diagnosis was confirmed as “denosumab-induced mandibular osteomyelitis.” Interventions: For the elderly patient with compromised overall health, an individualized comprehensive regimen combining conservative treatment and surgical debridement under local anesthesia was adopted. Outcomes: Following the comprehensive intervention combining conservative treatment and surgical debridement under local anesthesia, the patient’s clinical manifestations improved significantly: the surgical wound healed well. Lessons: This case emphasizes that clinicians must maintain heightened vigilance and consider alternative treatment options for vulnerable populations receiving denosumab therapy. Additionally, it highlights the urgent need for further research to thoroughly elucidate the pathogenic mechanisms and risk factors underlying denosumab-induced mandibular osteomyelitis.
Liu et al. (2026) studied this question.