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Is teriparatide therapy effective for medication-related osteonecrosis of the jaw? A systematic review and
L Dos Santos Ferreira1, L G Abreu2, C B Calderipe1
1Diagnostic Center for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, RS, Brazil.
Abstract:
Considering the lack of studies determining the real TPTD efficacy in individuals who develop MRONJ, our objective was to combine the available data on MRONJ cases treated with TPTD. The findings demonstrated that TPTD in combination with another therapy, especially antibiotic therapy, can be considered an effective protocol for MRONJ.
Purpose:
To integrate the data published on the effect of teriparatide (TPTD) therapy on cases of medication-related osteonecrosis of the jaws (MRONJ) into a comprehensive analysis of clinical features.
Methods:
An electronic search was undertaken in six databases. Descriptive analyses of clinicodemographic data of MRONJ were carried out. Poisson regression was also run to evaluate predictors of total resolution of MRONJ treated with TPTD.
Results:
Twenty-six publications comprising 111 cases were included. Most reported cases affected female individuals (82.0%) with a mean age of 76.54 years. Osteoporosis (76.5%) represented the main reason for using antiresorptive drugs, with bisphosphonates (98.1%) as the most frequently reported. Comorbidities were commonly present. The most related trigger factor of MRONJ was dental extraction (61.7%). Mandible (75.8%) was the most commonly affected site, with a mean evolution time of 5 months. MRONJ stage 2 (61.3%) was the most prevalent. Regarding TPTD treatment, in 45.1% cases, TPTD was used alone, with the total resolution being observed in 59.5% of the individuals. Associated therapy (54.9%) included surgery, antibiotic therapy, and laser therapy. Mean follow-up was 8.7 months. Poisson regression demonstrated that individuals with MRONJ stage 1 were 1.21 times more likely to present total resolution of osteonecrosis than individuals with MRONJ stage 3 (CI = 1.02-1.43; p < 0.023). Individuals who had undergone treatment with TPTD in association with another therapeutic modality were 1.21 times more likely to present total resolution of osteonecrosis than those who had undergone treatment with TPTD alone (CI = 1.40-1.39; p < 0.010).
Conclusion:
TPTD in combination with another therapy, especially antibiotic therapy, should be considered an effective therapeutic modality for MRONJ.
Insights
Teriparatide (TPTD) combined with other therapies, particularly antibiotics, shows effectiveness in treating medication-related osteonecrosis of the jaws (MRONJ). This combination therapy improves resolution rates compared to TPTD alone for MRONJ patients.
Area of Science:
- Oral and Maxillofacial Surgery
- Pharmacology
- Oncology
Background:
- Medication-related osteonecrosis of the jaws (MRONJ) is a significant complication associated with antiresorptive drugs, primarily bisphosphonates.
- Limited data exists on the efficacy of teriparatide (TPTD) in managing MRONJ, necessitating a comprehensive analysis of existing case studies.
- Understanding the clinical features and treatment outcomes of MRONJ is crucial for developing effective management strategies.
Purpose of the Study:
- To integrate and analyze published data on teriparatide (TPTD) therapy for medication-related osteonecrosis of the jaws (MRONJ).
- To provide a comprehensive overview of the clinical characteristics of MRONJ cases treated with TPTD.
- To evaluate the efficacy of TPTD, alone and in combination with other therapies, for MRONJ resolution.
Main Methods:
- Systematic electronic literature search across six databases.
- Descriptive analysis of clinicodemographic data from 111 MRONJ cases across 26 publications.
- Poisson regression analysis to identify predictors of MRONJ total resolution with TPTD treatment.
Main Results:
- The study analyzed 111 MRONJ cases, predominantly affecting elderly females (mean age 76.54 years) with osteoporosis as the primary reason for antiresorptive drug use (bisphosphonates).
- Mandibular involvement was most common (75.8%), with MRONJ stage 2 being prevalent (61.3%). Dental extraction was the most frequent trigger (61.7%).
- TPTD combined with other therapies (antibiotics, surgery, laser) resulted in higher total resolution rates (1.21 times more likely) compared to TPTD monotherapy. Stage 1 MRONJ showed better resolution likelihood than Stage 3.
Conclusions:
- Teriparatide (TPTD) in conjunction with other therapeutic modalities, especially antibiotic therapy, represents an effective treatment strategy for medication-related osteonecrosis of the jaws (MRONJ).
- Combination therapy with TPTD significantly enhances the likelihood of MRONJ resolution compared to TPTD alone.
- Early-stage MRONJ (Stage 1) demonstrates a higher probability of complete resolution following TPTD treatment.
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