J Korean Assoc Oral Maxillofac Surg.  2024 Oct;50(5):285-291. 10.5125/jkaoms.2024.50.5.285.

Successful treatment of adjunctive teriparatide therapy for medicationrelated osteonecrosis of the jaw: a report of two cases

• Kim Ry
• Hong So
• Jung Jw
• Lee Mh
• Lee Yk
• Jee Yj

• KMID: 2560824
• DOI: http://doi.org/10.5125/jkaoms.2024.50.5.285

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a refractory disease that can lead to severe destruction of the jaw. As there is no standard protocol for treating MRONJ, various treatments have been studied. Teriparatide has been used as an adjunct therapy for MRONJ. However, its effectiveness has not been sufficiently demonstrated for use as a standard treatment for MRONJ. This study aimed to demonstrate the efficacy of teriparatide in treating MRONJ by presenting two successfully treated cases. Each patient received teriparatide therapy with surgical intervention. The appropriateness of teriparatide use was evaluated based on the patient’s systemic condition, and the administration of teriparatide was supervised by a physician.Complete resolution of the lesion was observed clinically and radiographically in both patients. The first patient underwent implant placement at the lesion site. Due to its anabolic properties and ability to stimulate bone remodeling, teriparatide is an effective adjunctive pharmacological treatment for bone healing before and after surgery with associated beneficial effects on bone and mucosal healing.

Keyword

Bisphosphonate-associated osteonecrosis of the jaw; Teriparatide; Parathyroid hormone; Osteoporosis

Figure

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  Fig. 1 Panoramic radiograph on initial visit (upper left). Axial computed tomography (CT) view on initial visit (upper right). Coronal CT view on initial visit (lower left). Sagittal computed tomography CT view on initial visit (lower right).

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  Fig. 2 Postoperative panoramic radiograph at four months after sequestrectomy (upper left). Postoperative computed tomography axial, coronal, and sagittal views at 4 months after sequestrectomy (upper right, lower left, lower right, respectively) show persistent maxillary haziness.

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  Fig. 3 Panoramic radiograph after implantation at the lesion site (left). Intraoral radiograph 4 months after implantation (right).

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  Fig. 4 Panoramic radiograph on initial visit (left). Axial computed tomography view on initial visit (right).

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  Fig. 5 Preoperative panoramic radiograph at 7 months after teriparatide injection (left). Preoperative axial computed tomography view at 6 months after teriparatide injection (right) shows sequestrum separation.

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  Fig. 6 Panoramic radiograph at 2 months postoperatively (left). Panoramic radiograph at 4 months postoperatively (right).

Reference

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