Teriparatide therapy without surgical treatment for medication-related osteonecrosis of the jaw: a report of two cases
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Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication associated with antiresorptive or anticancer agents. Surgical intervention is generally recommended for advanced stages, but some patients may be ineligible for surgery due to systemic conditions or anatomical limitations. We present two patients who had been treated for osteoporosis with bisphosphonates and were diagnosed with stage 2 MRONJ. Their chief complaints included refractory pain, purulent discharge, and exposed bone following tooth extraction. Despite conservative treatment, the MRONJ worsened, prompting the initiation of teriparatide therapy. After teriparatide administration, the patients experienced symptom improvement, spontaneous sequestrum removal, and significant bone regeneration of vertical osteolysis. Teriparatide, a bone anabolic agent, is typically recommended as adjuvant therapy alongside surgical treatment for MRONJ. This case report illustrates the effectiveness of teriparatide monotherapy in the absence of surgical intervention, particularly for patients who cannot discontinue antiresorptive agents due to low bone mineral density.
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication associated with antiresorptive or anticancer agents. Surgical intervention is generally recommended for advanced stages, but some patients may be ineligible for surgery due to systemic conditions or anatomical limitations. We present two patients who had been treated for osteoporosis with bisphosphonates and were diagnosed with stage 2 MRONJ. Their chief complaints included refractory pain, purulent discharge, and exposed bone following tooth extraction. Despite conservative treatment, the MRONJ worsened, prompting the initiation of teriparatide therapy. After teriparatide administration, the patients experienced symptom improvement, spontaneous sequestrum removal, and significant bone regeneration of vertical osteolysis. Teriparatide, a bone anabolic agent, is typically recommended as adjuvant therapy alongside surgical treatment for MRONJ. This case report illustrates the effectiveness of teriparatide monotherapy in the absence of surgical intervention, particularly for patients who cannot discontinue antiresorptive agents due to low bone mineral density.
참고문헌 (20)
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