Denosumab-Induced Osteonecrosis of the Jaw with FDG PET/CT imaging features.

Denosumab is a monoclonal antibody that inhibits receptor activator of nuclear factor-kappa B ligand (RANKL), which plays a crucial role in osteoclast formation, function, and survival. By blocking RANKL, denosumab helps prevent bone resorption, making it an effective therapeutic option for managing conditions associated with bone metastases and osteopenia, such as in patients with lung cancer. Lung cancer, particularly non-small cell lung cancer (NSCLC), often metastasizes to bones, and denosumab is commonly used to reduce the incidence of skeletal-related events (SREs) in these patients. However, denosumab therapy is not without its risks, and one of the most significant side effects is osteonecrosis of the jaw (ONJ), a potentially debilitating condition characterized by bone exposure and necrosis, typically following dental extractions or trauma [1][2]. This case report explores the role of FDG PET/CT in diagnosing and managing Denosumab-induced ONJ in a patient with lung cancer, underscoring the value of this imaging modality in clinical practice.