# Atypical femoral fracture and jaw osteonecrosis under high doses of denosumab, healed with the aid of low dose of denosumab: a case report

## TL;DR

A patient with rare bone and jaw issues caused by high-dose denosumab treatment was successfully treated with a lower dose of the drug.

## Contribution

A novel low-dose denosumab regimen is proposed for managing atypical fractures and jaw osteonecrosis.

## Key findings

- A low-dose denosumab regimen led to successful bone healing in a patient with atypical femoral fractures.
- Osteonecrosis of the jaw resolved with the adjusted denosumab treatment.
- Bone turnover marker monitoring enabled personalized dosing adjustments.

## Abstract

Atypical femoral fractures (AFF) and osteonecrosis of the jaw (ONJ) are rare but serious complications associated with long-term use of antiresorptive therapies such as denosumab. Denosumab discontinuation to allow for bone healing is not possible because of the high risk of spontaneous multiple vertebral fractures. We present a case of concurrent AFF and ONJ in a patient previously treated with denosumab 120mg monthly. The patient was managed with a low-dose denosumab regimen tailored according to bone turnover marker monitoring, resulting in successful bone union and resolution of ONJ.