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Distinctive Role of 6-month-Teriparatide on Intractable Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ)

 K. M. Kim  ;  W. Park  ;  S. Y. Oh  ;  H.-J. Kim  ;  W. Nam  ;  S.-K. Lim  ;  Y. Rhee  ;  I. H. Cha 
 OSTEOPOROSIS INTERNATIONAL, Vol.25(5) : 1625-1632, 2014 
Journal Title
Issue Date
Aged ; Aged, 80 and over ; Biomarkers/blood ; Bisphosphonate-Associated Osteonecrosis of the Jaw/blood ; Bisphosphonate-Associated Osteonecrosis of the Jaw/diagnostic imaging ; Bisphosphonate-Associated Osteonecrosis of the Jaw/drug therapy* ; Bisphosphonate-Associated Osteonecrosis of the Jaw/physiopathology ; Bone Density/drug effects ; Bone Density Conservation Agents/therapeutic use* ; Bone Remodeling/drug effects ; Combined Modality Therapy ; Drug Evaluation/methods ; Female ; Femur Neck/physiopathology ; Hip Joint/physiopathology ; Humans ; Longitudinal Studies ; Lumbar Vertebrae/physiopathology ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Severity of Illness Index ; Teriparatide/therapeutic use* ; Treatment Outcome ; Vitamin D/blood
Bisphosphonate ; Jaw ; Osteonecrosis ; Teriparatide ; Vitamin D
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.
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.
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.
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.
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.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
2. College of Dentistry (치과대학) > Dept. of Advanced General Dentistry (통합치의학과) > 1. Journal Papers
2. College of Dentistry (치과대학) > Dept. of Oral and Maxillofacial Surgery (구강악안면외과학교실) > 1. Journal Papers
Yonsei Authors
Nam, Woong(남웅) ORCID logo https://orcid.org/0000-0003-0146-3624
Park, Wonse(박원서) ORCID logo https://orcid.org/0000-0002-2081-1156
Rhee, Yumie(이유미) ORCID logo https://orcid.org/0000-0003-4227-5638
Lim, Sung Kil(임승길)
Cha, In Ho(차인호) ORCID logo https://orcid.org/0000-0001-8259-2190
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