Administration of teriparatide improves the symptoms of advanced medication-related osteonecrosis of the jaw: preliminary findings

Objectives: Teriparatide is a synthetic polypeptide hormone that contains the 1–34 amino acid fragment of the recombinant human parathyroid hormone that stimulates bone formation. Currently it is approved only for the treatment of osteoporosis. Here, we report the outcomes of daily teriparatide injections for the treatment of medication-related osteonecrosis of the jaw in ten patients.
Methods: This study enrolled ten patients diagnosed as medication-related osteonecrosis of the jaw stage 2 or 3. Classification of the stage was based on the American Association of Oral and Maxillofacial Surgeons (AAOMS) Position Paper 2009. All patients received a daily 20 μg subcutaneous injection of teriparatide. The clinical findings evaluated included pain, pus discharge, exposure of necrotic bone in the oral cavity, and desensitization. C-terminal telopeptide of type 1 collagen (CTX), which is a biochemical marker of bone resorption, and Bone-Specific Alkaline Phosphatase (BAP), which is a bone formation marker, were measured at the initiation of the study, and at 3 or more months after the administration. Treatment outcomes, biochemical marker changes and radiographical image findings were assessed.
Results: Two of ten cases dropped out due to adverse events. Of the remaining eight cases, seven exhibited clinical improvement of the jaw-related symptoms of osteonecrosis and the progression of the sequestration, while one case did not show improvement of the symptoms.
Conclusions: Administration of teriparatide in patients with osteonecrosis of the jaw promotes bone formation and subsequent sequestration over a short period of time. Our results suggest that adjunctive teriparatide therapy is a viable and effective option for treating osteonecrosis of the jaw.