Original Article

Osteoporosis International

, Volume 25, Issue 5, pp 1625-1632

First online:

Distinctive role of 6-month teriparatide treatment on intractable bisphosphonate-related osteonecrosis of the jaw

  • K. M. KimAffiliated withDepartment of Internal Medicine, Seoul National University Bundang Hospital
  • , W. ParkAffiliated withDepartment of Advanced General Dentistry, Severance Dental Hospital, Yonsei University College of Dentistry
  • , S. Y. OhAffiliated withDepartment of Advanced General Dentistry, Severance Dental Hospital, Yonsei University College of Dentistry
  • , H.-J. KimAffiliated withDepartment of Oral and Maxillofacial Surgery, Severance Dental Hospital, Yonsei University College of Dentistry
  • , W. NamAffiliated withDepartment of Oral and Maxillofacial Surgery, Severance Dental Hospital, Yonsei University College of Dentistry
  • , S.-K. LimAffiliated withDepartment of Internal Medicine, Severance Hospital, Endocrine Research Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine
  • , Y. RheeAffiliated withDepartment of Internal Medicine, Severance Hospital, Endocrine Research Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine Email author 
  • , I. H. ChaAffiliated withDepartment of Oral and Maxillofacial Surgery, Severance Dental Hospital, Yonsei University College of Dentistry Email author 

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Abstract

Summary

The administration of teriparatide (TPTD) in conjunction with periodontal care could provide faster and more favorable clinical outcomes in previously refractory bisphosphonate-related osteonecrosis of the jaws (BRONJ) cases compared to conventional dental care, combination of surgery and antimicrobial treatment. We also found that underlying vitamin D levels might influence the response to TPTD treatment.

Introduction

Treatment of BRONJ is quite challenging and there are no standard treatment modalities. In this retrospective, longitudinal study, we examined whether additional TPTD administration could be beneficial for the resolution of BRONJ lesions compared to conservative management, such as antimicrobial treatment with or without surgery, and also studied the factors influencing the response to TPTD.

Methods

Twenty-four cases of intractable BRONJ were included: 15 subjects were assigned to the TPTD group and the other 9 subjects, who refused TPTD administration, were assigned to the non-TPTD group. All subjects in both groups continued calcium and vitamin D supplementation and the TPTD group additionally received a daily subcutaneous injection of 20 μg TPTD for 6 months.

Results

While 60.0 % of the non-TPTD group showed one stage of improvement in BRONJ, 40.0 % of the group did not show any improvement in disease status. In the TPTD group, 62.5 % of the treated subjects showed one stage of improvement and the other 37.5 % demonstrated a marked improvement, including two stages of improvement or complete healing, and there was not a single case that did not improve. The clinical improvement of BRONJ was statistically better in the TPTD group after the 6-month treatment (p < 0.05). Moreover, patients with higher baseline serum 25(OH)D levels showed better clinical therapeutic outcomes with TPTD.

Conclusions

We observed the beneficial effects of TPTD on BRONJ, and subjects with optimal serum vitamin D concentrations seemed to reap the maximum therapeutic effects of TPTD. A prospective, randomized, controlled trial should be needed to further evaluate the therapeutic efficacy of TPTD in the resolution of BRONJ.

Keywords

Bisphosphonate Jaw Osteonecrosis Teriparatide Vitamin D