Teriparatide Therapy for Alendronate-Associated Osteonecrosis of the Jaw

Austin Health, Melbourne, VIC, Australia .
New England Journal of Medicine (Impact Factor: 55.87). 10/2010; 363(25):2473-4. DOI: 10.1056/NEJMc1002684
Source: PubMed


To the Editor: An 88-year-old woman presented to our clinic with a 12-month history of pain, suppuration, and failed healing of a mandibular socket after tooth extraction, despite débridement and the administration of antibiotics. Computed tomographic imaging revealed necrosis of the left mandible consistent with the diagnosis of osteonecrosis of the jaw (Figure 1A and 1B). For 20 years, the patient had been taking prednisolone (at a dose of 5 mg per day) for the treatment of asthma. After a hip fracture 10 years earlier, she had begun taking 70 mg of alendronate per week, along with daily calcium carbonate (1500 mg) . . .

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Available from: Ada S Cheung, Oct 07, 2015
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    • "The subcutaneous administration of teriparatide hormone (rhPTH1–34) (11,12) and the surgical application of plasma rich in growth factors (PRF) (13,14) in the surgical site constitute two new alternative forms of BRONJ treatment that should be evaluated. "
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    ABSTRACT: Objectives: The aim of this study is to describe and compare the evolution of recurrent bisphosphonate-related osteonecrosis of the jaws (BRONJ) in patients treated with plasma rich in growth factors or teriparatide. Material and Methods: Two different types of treatments were applied in patients diagnosed of recurrent BRONJ in a referral hospital for 1.100.000 inhabitants. In the group A, plasma rich in growth factors was applied during the surgery. In the group B, the treatment consisted in the subcutaneous administration of teriparatide. All the cases of BRONJ should meet the following conditions: recurrent BRONJ, impossibility of surgery in stage 3 Ruggiero classification and absence of diagnosed neoplastic disease. Clinical and radiographic evolution of the patients from both groups was observed. Results: Nine patients were included, 5 in group A and 4 in group B. All the patients were women on oral bis-phosphonate therapy for primary osteoporosis (5 patients) or osteoporosis-related to the use of corticosteroids (4 patients). Alendronate was the most common oral bisphosphonate associated with BRONJ in our study (four patients in group A and two in group B). The mean age was 72,8 years in the group A and 73,5 years in the group B. All the patients from group A showed a complete resolution of their BRONJ. Only one patient in the group B showed the same evolution. Conclusions: In our series, the plasma rich in growth factors showed better results than the teriparatide in the treatment of recurrent BRONJ. Key words:Osteonecrosis, oral bisphosphonate, treatment, teriparatide, plasma rich in growth factors.
    Full-text · Article · Mar 2014 · Medicina oral, patologia oral y cirugia bucal
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    • "However the treatment with such a drug should be limited to 2 years because preclinical studies showed increased risk of osteosarcoma for longterm exposure. For this reason Teriparatide should not be recommended for patients with metastatic cancer [5] [6]. "
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    ABSTRACT: Purpose. To report the efficacy of conservative surgical treatment for stage I bisphosphonate-related osteonecrosis of the jaw (BRONJ). Materials and Methods. This study reports the clinical outcomes of 63 patients treated for BRONJ stage I (according to Ruggiero's staging system) at the Oral Pathology and Laser-Assisted Surgery Unit of the University of Parma between January 2004 and January 2011. Surgical interventions were performed, under local analgesia, in patients unresponsive for a period of six months to noninvasive treatments such as cycles of local or systemic antibacterial therapy combined or not to low level laser therapy, ozone therapy, or Hyperbaric Oxygen Therapy. All interventions were performed after the consultation of oncologist or physician. Results. In our experience, conservative surgical treatment is associated with the highest number of BRONJ healed sites in stage I disease. Complete healing was observed in 92.6% of sites surgically treated. Conclusions. This study confirms that treatment of patients affected by minimal bone exposition, (stage I of BRONJ), through conservative surgical strategies, possibly with laser, may result in a high control of the disease in the long term.
    Full-text · Article · Feb 2014 · International Journal of Dentistry
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    • "and activating the bone turnover by PTH can cure the BRONJ [35]. Therefore, problem in clinical utility of CTX in BRONJ treatment does not completely mean that the bone turnover is not important in understanding the pathophysiology of the BRONJ. "
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    ABSTRACT: Objective This study aimed to analyze the difference in biochemical markers of patients with osteoporosis taking bisphosphonates (BPs) who developed bisphosphonate-related osteonecrosis of the jaw (BRONJ) vs those who did not develop BRONJ.Patients & methodsForty-one BRONJ patients and 76 control patients who had been treated with alendronate or risedronate were investigated. Bone turnover markers [C-terminal telopeptide (CTX) and bone-specific alkaline phosphatase (bALP)] and inflammatory activity markers [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level] were evaluated. In BRONJ patients, radiographic severity and its relation with the serological data and BRONJ staging were analyzed.ResultsCTX and bALP level after the long-term BPs treatment in the control patients was similar to the level of the BRONJ patients at the time of diagnosis. The BRONJ patients showed a significantly higher ESR than the control patients with BPs. BRONJ score were not correlated with CTX and bALP. The severity of BRONJ in alendronate-treated group was strongly correlated with ESR and CRP.Conclusions Bone turnover markers such as serum CTX level has limitation in reflecting BRONJ status. Increased level of inflammatory markers in BRONJ patients implies the importance of inflammation in BRONJ progression.
    Full-text · Article · Apr 2013
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