BACKGROUND: The management of bisphosphonate-related osteonecrosis of the jaws (BRONJ) is challenging and controversial. At present, there is no established medication treatment for the disease. METHODS: A 78-year-old osteoporotic woman with osteonecrosis of the mandible related to alendronate therapy was referred for treatment. The disease was unresponsive to conservative therapy, including antibacterial mouth rinse, antibiotics, and minor surgical debridement. Teriparatide, a human recombinant pararthyroid hormone peptide 1-34, was then used for treatment. RESULTS: The oral mucosa completely regrew, and pain subsided 4 weeks after the initiation of teriparatide administration. Progressive bone regeneration was found during and after the 6-month period of teriparatide therapy. CONCLUSION: Our case demonstrated that teriparatide can be an important adjuvant in the management of advanced BRONJ and should be considered prior to major resection with reconstruction. Its true value in the treatment of BRONJ for noncancer patients with osteoporosis warrants future studies.
BACKGROUND: The management of bisphosphonate-related osteonecrosis of the jaws (BRONJ) is challenging and controversial. At present, there is no established medication treatment for the disease. METHODS: A 78-year-old osteoporoticwoman with osteonecrosis of the mandible related to alendronate therapy was referred for treatment. The disease was unresponsive to conservative therapy, including antibacterial mouth rinse, antibiotics, and minor surgical debridement. Teriparatide, a human recombinant pararthyroid hormone peptide 1-34, was then used for treatment. RESULTS: The oral mucosa completely regrew, and pain subsided 4 weeks after the initiation of teriparatide administration. Progressive bone regeneration was found during and after the 6-month period of teriparatide therapy. CONCLUSION: Our case demonstrated that teriparatide can be an important adjuvant in the management of advanced BRONJ and should be considered prior to major resection with reconstruction. Its true value in the treatment of BRONJ for noncancer patients with osteoporosis warrants future studies.
Authors: Luigi Cella; Aldo Oppici; Mariacristina Arbasi; Mauro Moretto; Massimo Piepoli; Daniele Vallisa; Adriano Zangrandi; Camilla Di Nunzio; Luigi Cavanna Journal: Head Face Med Date: 2011-08-17 Impact factor: 2.151