Teriparatide therapy for medication-related osteonecrosis of the jaw: case report and literature review
Abstract
We present the case of an 81-year-old lady with severe osteoporosis and ischaemic heart disease, who had been on Alendronate 70mg weekly for 3 years when she had a tooth extraction. 3 months later she presented to Maxillofacial Surgery with non-healing extraction sites, facial pain and erythema and a malodorous discharging sub-mantle sinus. She received a diagnosis of stage 3 MRONJ confirmed on Orthodentogram and CT scan. She had Proteus mirabilis on tissue culture. She had no history of osteosarcoma or local radiotherapy. Discussion: The biological rationale for the benefit of Teriparatide which is a recombinant Parathyroid hormone (rPTH) could lay in the fact that rPTH increases the proliferation of T-cells thereby increasing Wnt-10b production and enhancing osteoblast differentiation. 6 Teriparatide enhances osteoblast RANKL production to drive osteogenesis and augments osteoclast recruitment. 7 These cells are pivotal to bone healing and a prerequisite for the anabolic effect of Teriparatide on osteoblasts.
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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