Weekly teriparatide injections successfully treated advanced bisphosphonate-related osteonecrosis of the jaws
An 87-year-old Japanese woman with a 4-year history of alendronate therapy (35 mg/week orally) was referred for the treatment of multiple fistulas with purulent discharge over the left maxillary ridge. She was diagnosed with stage 3 BRONJ according to the AAOMS guidelines (2009). She initially received conservative treatment, including instruction on oral hygiene, administration of antibiotics, antimicrobial mouth gargles, and local irrigation. N-BP therapy was discontinued at the time of her first visit. Three months later, she underwent sequestrectomy and extraction of the maxillary left first and second molars because of high tooth mobility (Fig. , g). We continued conservative therapy and debridement for 1 year. However, her disease was persistent and progressive (Fig. , h). She was then treated with TPTD by subcutaneous injection (56.5 μg weekly). After 3 months of TPTD treatment, there was complete coverage of the necrotic tissue and exposed bone with normal mucosa. Computed tomography showed that her maxillary sinusitis attributed to stage 3 BRONJ had resolved (Fig. , i). Her s-NTX levels were slightly higher than the pretreatment level at 1 and 3 months after the initiation of TPTD treatment, and her serum P1NP level decreased after the initiation of TPTD treatment (Fig. ).