Abstract
While the optimal treatment concept of medication-related osteonecrosis of the jaws (MRONJ) is still in debate, several adjunct therapies have been introduced. Among these adjunctive measures, recombinant human parathyroid hormone (rhPTH, teriparatide) seems to be the most promising treatment modality. Several studies have presented the beneficial effect of short-term teriparatide; they have shown an improved level of bone markers and radiographic evidence of bone healing. Although clinical validation by a controlled trial with prospective design would be essential, short-term teripratide therapy would be a good treatment option for MRONJ patients with impaired bone remodeling.
Highlights
Bone tissue undergoes an incessant formation and resorption process which is called remodeling.During the postmenopause period, bone loss and structural weakening can be deepened
Teriparatide is a human recombinant peptide consisting of 1-34 amino acids of human parathyroid hormone which has 84 amino acids
Teriparatide is approved in the United States for the treatment of osteoporosis in postmenopausal women and in men who are at high risk of bone fracture
Summary
Bone tissue undergoes an incessant formation and resorption process which is called remodeling. The first 34 amino acids of human recombinant parathyroid hormone (rhPTH) have been approved for severe osteoporosis treatment. Parathyroid hormone is like a double-edged sword. It has both an anabolic and a catabolic effect on the bone, and the timing in which the exposure to this hormone happens is the critical determinant in the mode of action. The treatment modalities of MRONJ have evolved and adjunctive therapies have been introduced. Among the adjunct therapies, such as hyperbaric oxygen, teriparatide is thought to be the most investigated modality since it was first reported [2]. Use of rhPTH(1-34) can enhance bone regeneration potential in elderly patients and we were able to see improved bone markers in our MRONJ patients. Current knowledge of the use of teriparatide for MRONJ treatment will be reviewed.
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