Teriparatide therapy for bisphosphonate-related osteonecrosis of the jaw associated with dental implants.
This report describes a case of teriparatide (TPTD) therapy for bisphosphonate (BP)-related osteonecrosis of the jaw induced after implant placement. A 75-year-old woman taking oral BP was referred with uncontrolled osteonecrosis of the mandible related to the implant placement. With conservative treatment, BP was suspended and daily subcutaneous injections of 20 μm/d TPTD were started. After 4 months of the therapy, fixture removal and sequestrectomy were performed. Histological analysis revealed necrotic lamellar bone and empty osteocytic lacunae. In contrast, multiple irregular reversal lines of the lamellar bone and active osteoblasts were noted adjacent to the lesion. There was a significant increase in serum C-terminal telopeptide cross-link of type 1 collagen and serum osteocalcin after commencement of the therapy. After 7 months off therapy, the serum levels of the 2 markers remained at a high level compared with the baseline.
*Clinical Assistant Professor, Department of Advanced General Dentistry, Dankook University Dental Hospital, Cheonan, Korea. †Clinical Instructor, Department of Advanced General Dentistry, Yonsei University College of Dentistry, Seoul, Korea. ‡Associate Professor, Department of Internal Medicine, Endocrine Research Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea. §Associate Professor, Department of Oral Pathology, Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea. ‖Postgraduate Student, Department of Advanced General Dentistry, Yonsei University College of Dentistry, Seoul, Korea. ¶Associate Professor, Department of Advanced General Dentistry, Yonsei University College of Dentistry, Seoul, Korea.
Re-Mee
RM
Doh
Hye-Jeong
HJ
Park
Yumie
Y
Rhee
Hyun Sil
HS
Kim
Jisun
J
Huh
Wonse
W
Park
D000368:Aged; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000188:drug therapy* / Q000209:etiology; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015921:Dental Implants / Q000009:adverse effects*; D005260:Female; D006801:Humans; D019379:Teriparatide / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D050071:Bone Density Conservation Agents; D015921:Dental Implants; D019379:Teriparatide