Teriparatide Therapy for Alendronate-Associated Osteonecrosis of the Jaw

Article (PDF Available)inNew England Journal of Medicine 363(25):2473-4 · October 2010with25 Reads
DOI: 10.1056/NEJMc1002684 · Source: PubMed
Abstract
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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eriparatide Therapy for Alendronate-associated Osteonecrosis of the Jaw
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eriparatide Therapy for Alendronate-associated Osteonecrosis of the Jaw
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    • "Therefore, new methods of treatment and prevention for BRONJ are needed. Studies including small numbers of patients have been conducted to examine treatment with hyperbaric oxygen therapy [20], platelet-rich plasma [21], low-level laser irradiation [22], parathyroid hormone [23], and bone morphogenic protein [24]. Recent animal studies have demonstrated that intravenous injection (I.V.) of allogeneic multipotent mesenchymal stromal cells (MSCs) is effective for bone exposure in BRONJ-like animal models [25,26]. "
    [Show abstract] [Hide abstract] ABSTRACT: Statement of significance: Bisphosphonates are frequently used to treat osteoporosis, bone metastasis of various cancers, and other diseases. However, bisphosphonate related-osteonecrosis of the jaw (BRONJ) is an intractable disease because it often recurs after surgery or is exacerbated following conservative treatment. Therefore, an alternative approach for treating BRONJ is needed. In this study, we developed a bone marrow-derived multipotent mesenchymal stromal cell (MSC) sheet to treat BRONJ and investigated the effect of MSC sheet transplantation in a rat model of BRONJ-like disease. The MSC sheet transplantation group showed wound healing in most cases, while only minimal healing was observed in the control group and MSC intravenous injection group. Our results suggest that the MSC sheet is a promising alternative approach for the treatment of BRONJ.
    Article · Jun 2016
    • "1 3 gesetzt werden, da es die Knochenheilung verbessert. Diese Therapieoption gilt aber derzeit nicht für onkologische Patienten [5, 15, 28]. Für eine Vielzahl anderer experimenteller Behandlungsversuche gibt es noch keine validen Daten. "
    [Show abstract] [Hide abstract] ABSTRACT: It is now 12 years since the first article on medication-related osteonecrosis of the jaw (MRONJ) was reported in 2003. The recognition of MRONJ is still inconsistent between physicians and dentists but it is without doubt a severe disease with impairment of oral health-related quality of life. This position paper was developed by three Austrian societies for dentists, oral surgeons and osteologists involved in this topic. This update contains amendments on the incidence, pathophysiology, diagnosis, staging and treatment and provides recommendations for management based on a multidisciplinary international consensus. The MRONJ can be a medication-related side effect of treatment of malignant and benign bone diseases with bisphosphonates (Bp), bevacizumab and denosumab (Dmab) as antiresorptive therapy. The incidence of MRONJ is highest in the oncology patient population (range 1–15 %), where high doses of these medications are used at frequent intervals. In the osteoporosis patient population, the incidence of MRONJ is estimated to be 0.001–0.01 %, marginally higher than the incidence in the general population (< 0.001 %). Other risk factors for MRONJ include glucocorticoid use, maxillary or mandibular bone surgery, poor oral hygiene, chronic inflammation, diabetes mellitus, ill-fitting dentures as well as other drugs, including antiangiogenic agents. Prevention strategies for MRONJ include elimination or stabilization of oral disease prior to initiation of antiresorptive agents, as well as maintenance of good oral hygiene. In those patients at high risk for the development of MRONJ, including cancer patients receiving high-dose BP or Dmab therapy, consideration should be given to withholding antiresorptive therapy following extensive oral surgery until the surgical site heals with mature mucosal coverage. Management of MRONJ is based on the stage of the disease, extent of the lesions and the presence of contributing drug therapy and comorbidity. Conservative therapy includes topical antibiotic oral rinses and systemic antibiotic therapy. Early data have suggested enhanced osseous wound healing with teriparatide in those patients without contraindications for its use. The MRONJ related to denosumab may resolve more quickly with a drug holiday than MRONJ related to bisphosphonates. Localized surgical debridement is indicated in advanced nonresponsive disease and has proven successful. More invasive surgical techniques are becoming increasingly more important. Prevention is the key for the management of MRONJ. This requires a close teamwork for the treating physician and the dentist. It is necessary that this information is disseminated to other relevant health care professionals and organizations.
    Full-text · Article · Feb 2016
    • "Recently , there have been many reports that teriparatide may play positive roles in the treatment of ONJ. In 2010 Cheung and Seeman [127] treated an ONJ patient with teriparatide for 8 weeks, upon which the patient's symptoms improved and the ONJ area healed completely, leading the authors to report that teriparatide is effective as a treatment for ONJ. Also, another study was reported in that similar period in which teriparatide injection treatment was given for 6 weeks to patients with gingivitis who had pathological findings similar to ONJ, and the patients who received treatment showed improvement of markers related to gingivitis recovery compared to those who did not receive treatment. "
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    Full-text · Article · Dec 2015
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