Denosumab in the Treatment of Central Giant Cell Granuloma (CGCG)

Introduction: Central Giant-Cell Granulomas of the jaws (CGCG) are benign local destructive osteolytic lesions of osteoclastic origin accounting for less than 7% of all benign lesions of the jaws. CGCG is common in patients under the age of 30, with a clear female prevalence. The treatment options range from locally injection of drugs as steroids, anti TNF-α and calcitonin to extensive surgical resection. Denosumab is a human monoclonal antibody which Inhibits osteoclasts by binding to nuclear factor kB ligand (RANKL) and inhibits the maturation and the activity of osteoclast, the key cell that induces the osteolytic lesion.

Aim: To introduce Denosumab as an optional treatment of CGCG.

Case report / Materials and methods: Twelve y/o boy with an aggressive, rapidly growing, painful and destructive CGCG in the maxilla that was refractory to conservative treatment was referred to the endocrine unit. Sub-cutaneous 70mg/m2 (90 mg/dose) Denosumab injections were administrated once a week in the first month and once a month for the following 11 months. Calcium 2 gram/day and vitamin D 2000 units were added as well. PTH, calcium and alkaline phosphatase level and DXA were monitored.

Results: During treatment the lesion size reduced dramatically and new bone formation was observed. During the treatment there were declines in calcium levels that were ted well with calcium supplement. DAX Z score measurements at the end of the treatment were not elevated.

Conclusions: Denosumab was successfully used in patient with CGCG and should be considered as a therapeutic option for selected patients.