Adjunctive Denosumab Following Surgery in Pediatric Chronic Non-Bacterial Osteomyelitis of the Jaw: Does it Improve Outcomes? (An original research)

Introduction: Chronic non-bacterial osteomyelitis (CNO) is a rare autoinflammatory bone disorder predominantly observed in pediatric and adolescent populations. It is characterized by recurrent episodes of jaw pain and swelling, typically occurring in the absence of fever, and is differentiated from bacterial osteomyelitis by the sterile nature of cultures obtained from affected lesions. Clinically, CNO may manifest with osteolytic and sclerotic lesions that resemble those associated with bacterial infections; however, it is not attributable to infectious agents. The standard treatment regimen generally includes non-steroidal anti-inflammatory drugs (NSAIDs), with some patients necessitating opioid analgesics for the management of severe pain. Additionally, tumor necrosis factor-alpha (TNF-α) inhibitors and bisphosphonates are utilized in treatment, with bisphosphonates demonstrating therapeutic effects within a few weeks and often being recommended as a first-line intervention. Surgical approaches, such as decortication, have also been documented in the management of this condition. Recently, Denosumab has gained attention as a potential therapeutic option for CNO, given its established efficacy in treating conditions such as osteoporosis and metastatic bone disease, which have been associated with reduced fracture rates, diminished bone metastasis, and minimal significant adverse effects. This article seeks to assess the impact of incorporating Denosumab into a comprehensive treatment strategy that includes surgical interventions, and compare the outcomes with the control group that was treated surgically only without any administration of Denosumab post operatively. Material and methods: Between 2016 and 2024, a total of 45 pediatric patients diagnosed with CNO were admitted to the Department of Maxillofacial Surgery at the Russian Children’s Clinical Hospital, with diagnosis subsequently confirmed. All patients underwent surgical intervention, which involved decortication of the cortical layer of the jaw to restore the natural external contour, as well as curettage of the softened and inflamed jaw lesions using a Volkman’s spoon. Among these, 27 patients received a single postoperative administration of Denosumab, particularly in cases characterized by multiple relapses with brief remission intervals. Routine biochemical assessments were conducted to exclude renal dysfunction, and informed consent was obtained for the off-label use of Denosumab. Results: The findings indicate that while surgical treatment alone can achieve relapse-free outcomes in a substantial proportion of patients, the addition of Denosumab appears to extend remission intervals and mitigate relapse frequency and severity. Denosumab may therefore serve as a disease-modifying adjunct that supports more sustained disease control in pediatric CNO, although differences in baseline disease severity between patients should be considered when interpreting these outcomes. Conclusion: The management of CNO should be comprehensive, utilizing advanced antiresorptive therapies like monoclonal antibodies to improve patients’ outcomes. The authors highlight the ongoing question regarding the best dosages, treatment duration, and administration frequency of these medications to enhance effectiveness while reducing side effects. They emphasize the necessity for further research across various medical institutions to develop a universally accepted treatment protocol for CNO. © The Association of Oral and Maxillofacial Surgeons of India 2025.