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Teriparatide Promotes Bone Healing in Medication-Related Jaw Osteonecrosis
TAKE-HOME MESSAGE
- This double-blind, randomized, controlled trial evaluated 8 weeks of teriparatide versus placebo in managing medication-related osteonecrosis of the jaw. The patient population primarily consisted of individuals with multiple myeloma or breast or prostate bone metastatic disease, although some patients with osteoporosis were also enrolled.
- Teriparatide was associated with a higher rate of resolution of jaw osteonecrosis lesions (45% vs 33% at 52 weeks). Adverse events were mild in severity and similar between groups.
– Paul J. Hampel, MD
abstract
This abstract is available on the publisher's site.
Access this abstract nowPURPOSE
Medication-related osteonecrosis of the jaw (MRONJ) is an infrequent but morbid and potentially serious condition associated with antiresorptive and antiangiogenic therapies. Although MRONJ can be prevented by optimizing oral health, management of established cases is supportive and remains challenging. Teriparatide, an osteoanabolic agent that improves bone healing in preclinical studies and in chronic periodontitis, represents a potential treatment option.
PATIENTS AND METHODS
In a double-blind, randomized, controlled trial, 34 participants with established MRONJ, with a total of 47 distinct MRONJ lesions, were allocated to either 8 weeks of subcutaneous teriparatide (20 µg/day) or placebo injections, in addition to calcium and vitamin D supplementation and standard clinical care. Participants were observed for 12 months, with primary outcomes that included the clinical and radiologic resolution of MRONJ lesions. Secondary outcomes included osteoblastic responses as measured biochemically and radiologically and changes in quality of life.
RESULTS
Teriparatide was associated with a greater rate of resolution of MRONJ lesions (odds ratio [OR], 0.15 v 0.40; P = .013), and 45.4% of lesions resolved by 52 weeks compared with 33.3% in the placebo group. Teriparatide was also associated with reduced bony defects at week 52 (OR, 8.1; P = .017). The incidence of adverse events was balanced between groups, including nausea, anorexia, and musculoskeletal pain, most of mild severity.
CONCLUSION
Teriparatide improves the rate of resolution of MRONJ lesions and represents an efficacious and safe treatment for it.
Additional Info
Disclosure statements are available on the authors' profiles:
Teriparatide Promotes Bone Healing in Medication-Related Osteonecrosis of the Jaw: A Placebo-Controlled, Randomized Trial
J. Clin. Oncol 2020 Jul 02;[EPub Ahead of Print], IW Sim, GL Borromeo, C Tsao, R Hardiman, MS Hofman, C Papatziamos Hjelle, M Siddique, GJR Cook, JF Seymour, PR EbelingFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
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