Effective ancillary role and long-term course of daily or weekly teriparatide treatment on refractory medication-related osteonecrosis of the jaw: a clinical case series |
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| Affiliation: | 1. Department of Science of Physical Function, Division of Oral Medicine, Kyushu Dental University, Fukuoka, Japan;2. Department of Science of Physical Function, Division of Maxillofacial Surgery, Kyushu Dental University, Fukuoka, Japan;1. Department of Oral and Maxillofacial Surgery, Leipzig University, Liebigstraße 12, 04103 Leipzig, Germany;2. Department of Surgical Sciences, Faculty of Dentistry, Kuwait University, Safat, Kuwait;3. Faculty of Mechanical and Energy Engineering, University of Applied Sciences (HTWK), Karl- Liebknecht Str. 145, 04277 Leipzig, Germany;4. Department of Ophthalmology, Leipzig University, Liebigstraße 12, 04103 Leipzig, Germany;1. Master''s student in Orofacial Harmonization - European Face Institute, Porto, Portugal;2. Oral and Maxillofacial Surgeon, Master in Oral and Maxillofacial Surgery, PhD in Oral and Maxillofacial Sugery, Maxillofacial Program Director - European Face Institute, Porto, Portugal;1. Echterdinger Straße 7, 70794 Filderstadt, Germany;2. Department of Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Augustusplatz 2, 55131 Mainz, Germany;3. Departmental Library for the University Medical Centre, University of the Johannes Gutenberg University of Mainz, Langenbeckstr.1, 55131 Mainz, Germany;4. Department of Prosthetic Dentistry, University Medical Centre of the Johannes Gutenberg University of Mainz, Augustusplatz 2, 55131 Mainz, Germany |
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| Abstract: | Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe adverse side effect of antiresorptive agents. However, withdrawal of such agents in patients with osteoporosis may increase the risk of fracture. The treatment of MRONJ is challenging, and standard treatment guidelines have yet to be established. In this study, the aim was to find out whether adjuvant daily or weekly teriparatide (TPTD) injections were beneficial for exposed bony MRONJ lesions compared with standard conservative management. We also studied the complications and the patients’ response to TPTD therapy. We enrolled 27 patients (January 2012 - December 2016) with chronic and refractory MRONJ. There were four men and 23 women (85% female). Nine patients who did not select TPTD therapy for several reasons formed the non-TPTD group; the remaining 18 were randomly assigned to the daily (n=9) or weekly (n=9) groups. All patients in both groups continued standard conservative therapy in addition to their daily or weekly subcutaneous injection of TPTD (20 μg or 56.5 μg, respectively). We evaluated the complications of TPTD and its benefits. Three patients in the daily group did not complete the study, resulting in six patients in the daily group, nine in the weekly group, and nine in the non-TPTD group in the final analysis. The exposed bone was completely covered with normal mucosa in all patients in the TPTD groups, and the healing period was shorter than that in the non-TPTD group. No patient had complications of atypical fractures of the femoral head. Daily and weekly TPTD treatment resulted in a shortened treatment period compared with standard conservative therapy, with no increase in the rate of complications or worsening of osteoporosis. |
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| Keywords: | Bisphosphonate BRONJ MRONJ Osteoporosis Teriparatide |
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