There have been recent reports of osteonecrosis of the jaws developing after exposure to drugs other than BPs [41, 42]. The most alarming results were associated with denosumab, which is a fully human monoclonal antibody that inhibits the maturation of osteoclasts. The first reports of osteonecrosis developing after exposure to denosumab appeared in 2010 [43, 44], with the most extensive study having been prospectively conducted on 5,723 cancer patients [45]. Those patients were randomly assigned to receive either denosumab or zoledronic acid. Oral adverse events were determined by an independent blinded committee of dental experts. The overall incidence of osteonecrosis was 1.6 % (89 patients), most of whom (52 vs. 37) developed under denosumab. Again, as expected, tooth extraction was reported in 61.8 % of the affected patients [45]. The conclusion that can be drawn from the comparative studies listed in Table 5.2 is that osteonecrosis related to the administration of denosumab might be similar or even more prevalent than with intravenous BPs and that comparable or even higher incidence rates of MRONJ development after exposure to denosumab might be expected.