Weekly teriparatide injections successfully treated advanced bisphosphonate-related osteonecrosis of the jaws
An 81-year-old Japanese woman with a 5-year history of alendronate therapy (35 mg/week orally) was admitted for the treatment of a pathological mandibular fracture. After hospitalization, the teeth of the right mandible were naturally detached after cutting the bridge; consecutively, metal crowns were used. She was diagnosed with stage 3 BRONJ and stopped her alendronate therapy after consultation with her physician. She had infection of both the bone and soft tissues (Fig. , c). We advised surgical treatment, but this was refused by the patient and her family. We administered conservative treatment for BRONJ and the mandibular fracture, including infection control and use of a chin cap to limit movement of the jaw. After 2 months, her disease was persistent and the fracture was still mobile. We started TPTD treatment by subcutaneous injection (20 μg per day). Three months later, her symptoms had resolved. The osteonecrosis had healed and was covered by normal mucosa. Computed tomography showed partial healing of the mandibular fracture (Fig. , f). Her s-NTX and P1NP levels were low at the first visit. Her s-NTX levels were slightly increased compared with the pretreatment level at 2 and 4 months after the initiation of TPTD treatment, and her serum P1NP level was significantly increased at 2 months after the initiation of TPTD treatment (Fig. ).