Two cases of tooth resorption in patients receiving denosumab therapy

Authors

• Emily Y. Chu, University of Maryland, Baltimore, MD
• Eswar Kandaswamy, LSU Health Sciences Center - New OrleansFollow
• Vinayak Joshi, LSU Health Sciences Center - New OrleansFollow
• Janina Golob Deeb, Virginia Commonwealth University, Richmond, VA
• Mauricio Ronderos, Periodontics and Dental Implants Center, Redwood City, CA
• Stephen P. Russo, Periodontics LLC, Skokie, IL
• Golnar Jahanmir, National Institute of Dental and Craniofacial Research, Bethesda, MD
• Vardit Kram, National Institute of Dental and Craniofacial Research, Bethesda, MD
• Alison Boyce, National Institute of Dental and Craniofacial Research, Bethesda, MD
• Martha Somerman, Frontiers in Dental Medicine, Chevy Chase, MD
• Vivek Thumbigere-Math, University of Maryland, Baltimore, MD

Document Type

Article

Publication Date

3-2-2026

Publication Title

Journal of the American Dental Association

Abstract

Background: Multiple external cervical root resorption (MECRR) is a rare, aggressive form of root resorption affecting multiple permanent teeth at the cementoenamel junction. A possible association between denosumab (DMAb), a receptor activator of nuclear factor-κB ligand (RANKL)-inhibiting antiresorptive medication, and MECRR has been proposed, although evidence remains limited. Case Description: Two retrospective cases of MECRR were identified, including a 72-year-old woman receiving DMAb for osteoporosis and a 65-year-old man receiving high-dose DMAb for metastatic prostate cancer. In both cases, MECRR was first detected approximately 5 years after beginning DMAb therapy, without known predisposing factors. Lesions progressed despite professional intervention and rapidly worsened after DMAb cessation. Histology revealed multinucleated clastic cells with external resorption of cementum and dentin. One hypothesis is that localized, RANKL-independent osteoclastogenesis may potentially contribute to MECRR during DMAb treatment, subsequently exacerbated by rebound osteoclast activity on drug withdrawal. Practical Implications: These cases illustrate a temporal association between DMAb therapy and MECRR but do not establish causality. Early recognition in patients receiving DMAb is important given the irreversible nature of MECRR. Interdisciplinary communication is important, and prospective and mechanistic studies are needed to clarify risk factors and develop preventive strategies.

PubMed ID

41770180

Recommended Citation

Chu, Emily Y.; Kandaswamy, Eswar; Joshi, Vinayak; Deeb, Janina Golob; Ronderos, Mauricio; Russo, Stephen P.; Jahanmir, Golnar; Kram, Vardit; Boyce, Alison; Somerman, Martha; and Thumbigere-Math, Vivek, "Two cases of tooth resorption in patients receiving denosumab therapy" (2026). School of Dentistry Faculty Publications. 244.
https://digitalscholar.lsuhsc.edu/sod_facpubs/244
10.1016/j.adaj.2026.01.007