J Korean Assoc Oral Maxillofac Surg.  2024 Apr;50(2):103-109. 10.5125/jkaoms.2024.50.2.103.

Adjunctive recombinant human parathyroid hormone agents for the treatment of medication-related osteonecrosis of the jaw: a report of three cases

• Choi SY
• Yoon D
• Kim KM
• Kim SJ
• Kim HY
• Kim JW
• Park JH

• KMID: 2555740
• DOI: http://doi.org/10.5125/jkaoms.2024.50.2.103

Abstract

Teriparatide has been effective in treating people diagnosed with medication-related osteonecrosis of the jaw (MRONJ). However, its efficacy is not well established to be accepted as a standard of care. The objective of this paper was to investigate the efficacy of recombinant human parathyroid hormone for the treatment of MRONJ. We report three cases of MRONJ patients with osteoporosis as the primary disease who were treated with a teriparatide agent along with other adjunctive measures. Each patient was administered a teriparatide injection subcutaneously for 16 weeks, 36 weeks, or 60 weeks. Surgical intervention including partial resection, sequestrectomy, decortication, and saucerization took place during the teriparatide administration. Complete lesion resolution was identified clinically and radiographically in all three patients. In patients diagnosed with MRONJ, teriparatide therapy is an efficacious and safe therapeutic option to improve healing of bone lesions. These findings demonstrate that teriparatide in combination with another therapy, especially bone morphogenetic protein, platelet-rich fibrin, or antibiotic therapy, can be an effective protocol for MRONJ.

Keyword

Teriparatide; Human parathyroid hormone (1-34); Forteo; Bisphosphonate-associated osteonecrosis of the jaw; Osteoporosis

Figure

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  Fig. 1 Clinical photo of an extra-oral fistula with purulent discharge in the left mandibular area on initial visit (left). Clinical intraoperative photos of a left mandibular cortical defect (upper right) and removal of sequestrum (lower right). The sequestrum was isolated from the mandible.

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  Fig. 2 Preoperative panoramic view (upper left) shows invasion of the inferior border of the mandible. Postoperative panoramic view (lower left) at seven months shows recovery at the inferior border of the mandible. Reconstructed views of the preoperative (upper right) and postoperative (lower right) lesion.

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  Fig. 3 Sagittal view of the left maxillary sinusitis area (upper right) shows oro-antral communication (stage 3). Coronal view of the left maxillary sinusitis area (upper left) with trabecular sclerosis. Axial view of cortical erosion and trabecular sclerosis in the left maxillary anterior area (lower right). Initial bone scintigraphy shows increased uptake in the left maxillary alveolar process along with mild uptake in the left zygomatic arch (lower left).

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  Fig. 4 Patient follow up with bone SPECT/CT (single-photon emission computed tomography/computed tomography) at four (right) and eight months postoperatively (left), showing marked decrease in uptake intensity.

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  Fig. 5 Bone scintigraphy at two (upper right) and eight (upper left) months postoperatively. Improved osteonecrosis on the right mandible was confirmed. Computed tomography (CT) showed cortical erosion extending to the mesial surface of the right first premolar area (lower right). Postoperative two-month CT shows normal trabecular bone healing on the debrided area (lower left).

Reference

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