title: Alternative treatments for oral bisphosphonate-related osteonecrosis of the jaws: a pilot study comparing fibrin rich in growth factors and teriparatide.
abstract: OBJECTIVE
  The aim of this study is to describe and compare the evolution of recurrent bisphosphonate-related osteonecrosis of the jaws (BRONJ) in patients treated with plasma rich in growth factors or teriparatide.
  
  
  METHODS
  Two different types of treatments were applied in patients diagnosed of recurrent BRONJ in a referral hospital for 1.100.000 inhabitants. In the group A, plasma rich in growth factors was applied during the surgery. In the group B, the treatment consisted in the subcutaneous administration of teriparatide. All the cases of BRONJ should meet the following conditions: recurrent BRONJ, impossibility of surgery in stage 3 Ruggiero classification and absence of diagnosed neoplastic disease. Clinical and radiographic evolution of the patients from both groups was observed.
  
  
  RESULTS
  Nine patients were included, 5 in group A and 4 in group B. All the patients were women on oral bisphosphonate therapy for primary osteoporosis (5 patients) or osteoporosis-related to the use of corticosteroids (4 patients). Alendronate was the most common oral bisphosphonate associated with BRONJ in our study (four patients in group A and two in group B). The mean age was 72,8 years in the group A and 73,5 years in the group B. All the patients from group A showed a complete resolution of their BRONJ. Only one patient in the group B showed the same evolution.
  
  
  CONCLUSIONS
  In our series, the plasma rich in growth factors showed better results than the teriparatide in the treatment of recurrent BRONJ.
authors.affiliation: Universidad de Oviedo, Facultad de Ciencias de la Salud, Catedrático José Serrano s/n, 33009, Oviedo, Spain, junquera@uniovi.es.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Pelaz
authors.forename: Luis
authors.initials: L
authors.lastname: Junquera
authors.forename: Lorena
authors.initials: L
authors.lastname: Gallego
authors.forename: Luis
authors.initials: L
authors.lastname: García-Consuegra
authors.forename: Sonsoles
authors.initials: S
authors.lastname: Junquera
authors.forename: Carlos
authors.initials: C
authors.lastname: Gómez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000188:drug therapy*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D005260:Female; D005337:Fibrin / Q000627:therapeutic use*; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000627:therapeutic use*; D008875:Middle Aged; D010865:Pilot Projects; D019379:Teriparatide / Q000627:therapeutic use*
chemical_list: D050071:Bone Density Conservation Agents; D036341:Intercellular Signaling Peptides and Proteins; D019379:Teriparatide; D005337:Fibrin