Experience with the targeted treatment of diffuse sclerosing jaw osteomyelitis in children

Introduction. Diffuse sclerosing osteomyelitis is a rare and difficult to treat disease of the jaw. Currently, many options for conservative and surgical treatment have been proposed, but none of them has significant and stable results. Bisphosphonate drugs (ibandronate) has been recently recommended as an alternative for osteomyelitis exacerbation treatment. A similar antiresorptive effect was demonstrated for denosumab — human monoclonal antibody to the receptor-activator of the nuclear factor kappa-B ligand (RANKL).

Material and methods. Two patients with histologically confirmed diffuse sclerosing osteomyelitis of the lower jaw, after unsuccessful conservative treatment and necrectomy, received a single subcutaneous injection  of denosumab (60 mg), followed by transfer to oral administration of alendronic acid.

Results. The use of the denosumab allowed to stop the pain; the inflammatory activity in the bones decreased and the density of foci in the bone tissue decreased, according to control computed tomography data.

Conclusion. Antiresorptive treatment with denosumab can be considered as an alternative treatment for patients suffering from persistent recurrent osteomyelitis. However, further studies are necessary to find out the mechanisms of action and determine the necessary dose of the drug, as well as the intervals of use.

Key words: diffuse sclerosing osteomyelitis, denosumab, bisphosphonates, alendronate, fibrous dysplasia, chronic, osteomyelitis

Conflicts of interest. The authors have no conflicts of interest to declare.

Funding. There was no funding for this study.