Endocrine Abstracts

Introduction: Diffuse sclerosing osteomyelitis (DSO) of the jaw is a chronic and rare condition that can present with recurrent and severe jaw pain and mandibular swelling. The treatment of this condition can often be quite challenging. We present a patient with mandibular DSO who had significant improvement in jaw pain with denosumab injections.

Clinical Case: A 23-year-old female presented with left mandible pain for 4 years. Her symptoms started after a blunt trauma to her jaw. Based on clinical features and CT scan findings, she was diagnosed with chronic non-infectious osteomyelitis of the jaw. She was treated with oral appliances, trigger point injections, analgesics, anti-inflammatory medications, and oral steroids but only had minimal and temporary resolution in her pain. She was seen in endocrinology clinic and received denosumab which resulted in significant improvement and about 50% reducation in jaw pain. A second injection of denosumab was given 6 months later with continued improvement in her symptoms. Repeat imaging after denosumab injections revealed stable thickening and sclerotic signal changes in the body and angle of the left mandible corresponding to chronic osteomyelitis, without additional osseous abnormalities.

Discussion: There have been several medical and surgical options proposed to treat DSO. The typical medical treatment options include anti-inflammatory drugs, intravenous or oral antibiotics, corticosteroids, and analgesics for pain control. The medical treatment might often require several months and may not provide adequate pain control. There have been limited number of reports of using antiresorptive medications including bisphosphonates and denosumab to control pain and inflammatory activity in DSO. These antiresorptive treatments can potentially reduce pain and swelling via direct inhibition of the osteoclast activity that plays an important role in pathogenesis of DSO. Our patient with DSO experienced significant pain relief after denosumab injections. Given the potential risk of medication related osteonecrosis of the jaw (MRONJ) with antiresorptives, denosumab has the advantage of having a shorter half-life in bone compared with bisphosphonates thus decreasing the duration of risk for MRONJ.

Conclusion: Denosumab may be a promising treatment option for pain control in DSO. Additional studies are needed to further study the effects of denosumab and its roles in treatment of DSO.