Teriparatide Promotes Bone Healing in Medication-Related Osteonecrosis of the Jaw: A Placebo-Controlled, Randomized Trial

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Ie-Wen Sim 1 2, Gelsomina L Borromeo 3, Claudine Tsao 3, Rita Hardiman 3, Michael S Hofman 4, Christian Papatziamos Hjelle 5, Musib Siddique 5, Gary J R Cook 5, John F Seymour 1 6, Peter R Ebeling

Main idea: Teriparatide improves the rate of resolution of medication-related osteonecrosis of the jaw lesions and represents an efficacious and safe treatment for it.

Abstract

Purpose: Medication-related osteonecrosis of the jaw (MRONJ) is an infrequent but morbid and potentially serious condition associated with antiresorptive and antiangiogenic therapies. Although MRONJ can be prevented by optimizing oral health, management of established cases is supportive and remains challenging. Teriparatide, an osteoanabolic agent that improves bone healing in preclinical studies and in chronic periodontitis, represents a potential treatment option.

Patients and methods: In a double-blind, randomized, controlled trial, 34 participants with established MRONJ were given teriparatide or a placebo. Participants were observed for 12 months. Primary outcomes included the clinical and radiologic resolution of MRONj lesions. Secondary outcomes included osteoblastic responses as measured biochemically and radiologically and changes in quality of life. Results: Teriparatide was associated with a greater rate of resolution of MRONJ lesions. 45.4% of lesions resolved by 52 weeks compared with 33.3% in the placebo group. Incidence of adverse events was balanced between groups, including nausea and anorexia, and musculoskeletal pain, most of mild severity.

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