Teriparatide for the Treatment of Medication-Related Osteonecrosis of the Jaw

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a painful and intractable disease of the jaw that clinically presents as an area of ulceration with exposed necrotic bone. In severe cases, it can predispose to jaw fracture, skin fistula, or osteolysis extending beyond the region of the alveolar bone. No effective treatment has been established for this condition. Recently, teriparatide, a recombinant parathyroid hormone, and the only FDA-approved osteoanabolic drug for the treatment of glucocorticoid-induced osteoporosis, has been used for the treatment of MRONJ. We review the literature highlighting the effectiveness of teriparatide alone or as an adjunct in the treatment of MRONJ. Twenty publications met our selection criteria, comprising 54 patients with stage 2 or 3 MRONJ secondary to antiresorptive/antiangiogenic drugs. Trauma due to implant placement was the most common triggering factor for the development of MRONJ. Patients were treated with subcutaneous injections of 20-μg teriparatide for 3–12 months (5 1/2 months average). Symptomatic relief was achieved in almost all cases, with lesions healing completely in 49 of 54 patients. Based on our findings, teriparatide can play an important role in the treatment of MRONJ.

Comparative clinical study of phosphorous necrosis and medical-related osteonecrosis of the jaws

“…For instance, recent studies have shown that parathyroid hormone has an osteogenic-inducing function and can stimulate osteogenesis [28] . Recombinant parathyroid hormone1-34 (rhPTH1-34, commercial name teriparatide) has demonstrated remarkable clinical e cacy in MRONJ [29][30][31] . Therefore, rhPTH1-34 may be the therapeutic target for PNJ, although further research is required to con rm this hypothesis, opening up the possibility of teriparatide treatment for patients with PNJ.…”

Pharmacological intervention of the FGF–PTH axis as a potential therapeutic for craniofacial ciliopathies

“…Teriparatide acetate effectively reduces bone resorption and has shown promising results in phase 4 trials ( Leder, 2017 ). It has been successfully used for the treatment of BRONJ ( Chopra and Malhan, 2020 ; Dos Santos Ferreira et al, 2021 ; Kwon and Kim, 2016 ; Sim et al, 2020 ; Yu and Su, 2020 ), and reduced serum calcium levels and improved bone integrity in osteoporosis and hypoparathyroidism patients ( Gutierrez-Cerecedo et al, 2016 ; Satterwhite et al, 2010 ). Considering the variable efficacy and side effects in human patients, it will be important to carefully examine other osteoporosis-approved drugs (Denosumab, etc.)…”

Pharmacological intervention of the FGF-PTH axis as a potential therapeutic for craniofacial ciliopathies

“…TA effectively reduces bone resorption and has shown promising results in phase 4 trials (Leder, 2017). TA has been successfully used for the treatment of BRONJ (Chopra and Malhan, 2020; Dos Santos Ferreira et al, 2021; Kwon and Kim, 2016; Sim et al, 2020; Yu and Su, 2020), and reduced serum calcium levels and improved bone integrity in osteoporosis and hypoparathyroidism patients (Gutierrez-Cerecedo et al, 2016; Satterwhite et al, 2010). Considering the variable efficacy and side effects in human patients, it will be important to carefully examine other osteoporosis-approved drugs (Denosumab, etc.)…”