title: Adjunct teriparatide therapy with monitoring of bone turnover markers and bone scintigraphy for bisphosphonate-related osteonecrosis of the jaw.
abstract: The management of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is still difficult in many cases that do not respond to conservative treatments. We report a case of BRONJ treated by adjunctive teriparatide therapy for 6 months with monitoring of bone turnover markers (at baseline, at 1, 3, and 6 months of treatment, and after 9 months off therapy) and bone scintigraphy (at baseline, 3 and 6 months, and after 9 months off therapy). The patient was a 78-year-old woman with osteoporosis and BRONJ. She had not responded to previous conventional treatment. Teriparatide was added for resolution of BRONJ. The pain disappeared after 1 month, and remarkable bone regeneration was obtained after 6 months, with significantly increasing bone formation and resorption markers. Bone scintigraphy showed regression of the uptake area. This case suggests the usefulness of monitoring bone turnover markers and using bone scintigraphy to increase the effectiveness of teriparatide therapy.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan. yumiko@med.kagawa-u.ac.jp
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Ohbayashi
authors.forename: Minoru
authors.initials: M
authors.lastname: Miyake
authors.forename: Fumi
authors.initials: F
authors.lastname: Sawai
authors.forename: Yuko
authors.initials: Y
authors.lastname: Minami
authors.forename: Akinori
authors.initials: A
authors.lastname: Iwasaki
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Matsui
mesh_terms: D000135:Acid Phosphatase / Q000032:analysis; D000368:Aged; D019386:Alendronate / Q000009:adverse effects; D000469:Alkaline Phosphatase / Q000032:analysis; D000596:Amino Acids / Q000652:urine; D015415:Biomarkers / Q000032:analysis; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000000981:diagnostic imaging / Q000188:drug therapy*; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001861:Bone Regeneration / Q000502:physiology; D001862:Bone Resorption / Q000503:physiopathology; D024042:Collagen Type I / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007527:Isoenzymes / Q000032:analysis; D008334:Mandible / Q000000981:diagnostic imaging; D008336:Mandibular Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015675:Osteocalcin / Q000097:blood; D010012:Osteogenesis / Q000502:physiology; D010446:Peptide Fragments / Q000032:analysis; D010455:Peptides / Q000652:urine; D011347:Procollagen / Q000032:analysis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D000071681:Tartrate-Resistant Acid Phosphatase; D013669:Technetium Tc 99m Medronate; D019379:Teriparatide / Q000627:therapeutic use*
chemical_list: D000596:Amino Acids; D015415:Biomarkers; D050071:Bone Density Conservation Agents; D024042:Collagen Type I; D007527:Isoenzymes; D010446:Peptide Fragments; D010455:Peptides; D011347:Procollagen; D019275:Radiopharmaceuticals; C052929:collagen type I trimeric cross-linked peptide; C047202:procollagen Type I N-terminal peptide; D015675:Osteocalcin; D019379:Teriparatide; C036020:deoxypyridinoline; D000469:Alkaline Phosphatase; D000135:Acid Phosphatase; D000071681:Tartrate-Resistant Acid Phosphatase; D019386:Alendronate; D013669:Technetium Tc 99m Medronate