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Teriparatide Therapy for Bisphosphonate-Associated Osteonecrosis of the Jaw in an Elderly Japanese Woman with Severe Osteoporosis

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Abstract

We report on the case of a severely osteoporotic elderly Japanese woman with bisphosphonate-associated osteonecrosis of the jaw (ONJ), who was treated successfully with teriparatide. A 79-year-old woman with severe osteoporosis and bisphosphonate-associated ONJ was treated with teriparatide after debridement of the necrotic tissue in the jaw bone. Computed tomography (CT) images revealed the bone defect in the mandible after debridement of the necrotic tissue associated with ONJ. According to the attending dentist, the ONJ healed after 2 months of therapy. After 3 months of treatment, a robust increase in the serum level of the bone formation marker, serum intact procollagen type 1 N-terminal propeptide, was noted and a repeat CT revealed improvement of the bone defect of the mandible. These results suggest the beneficial effects of teriparatide therapy in the severely osteoporotic elderly woman with ONJ.

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Table I

References

  1. Cavanna L, Bertè R, Arcari A, et al. Osteonecrosis of the jaw: a newly emerging site-specific osseous pathology in patients with cancer treated with bisphosphonates. Report of five cases and review of the literature. Eur J Int Med 2007; 18: 417–22

    CAS  Google Scholar 

  2. Melo MD, Obeld G. Osteonecrosis of the jaws in patients with a history of receiving bisphosphonate therapy: strategies for prevention and early detection. J Am Dent Assoc 2005; 136: 1675–81

    CAS  PubMed  Google Scholar 

  3. Yarom N, Yahalom R, Shoshani Y, et al. Osteonecrosis of the jaw induced by orally administered bisphosphonates: incidence, clinical features, predisposing factors and treatment outcome. Osteoporos Int 2007; 18: 1363–70

    Article  CAS  PubMed  Google Scholar 

  4. Badros A, Weikel D, Salama A, et al. Osteonecrosis of the jaw in multiple myeloma patients: clinical features and risk factors. J Clin Oncol 2006; 24: 945–52

    Article  CAS  PubMed  Google Scholar 

  5. Harper RP, Fung E. Resolution of bisphosphonate-associated osteonecrosis of the mandible: possible application for intermittent low-dose parathyroid hormone [rhPTH(1–34)]. J Oral Maxillofac Surg 2007; 65: 573–80

    Article  PubMed  Google Scholar 

  6. Lau AN, Adachi JD. Resolution of osteonecrosis of the jaw after teriparatide [recombinant human PTH-(1–34)] therapy. J Rheumatol 2009; 36: 1835–7

    Article  CAS  PubMed  Google Scholar 

  7. Cheung A, Seeman E. Teriparatide therapy for alendronate-associated osteonecrosis of the jaw. N Engl J Med 2010; 363: 2473–4

    Article  CAS  PubMed  Google Scholar 

  8. Bashutski JD, Eber RM, Kinney JS, et al. Teriparatide and osseous regeneration in the oral cavity. N Engl J Med 2010; 363: 2396–405

    Article  CAS  PubMed  Google Scholar 

  9. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001; 344: 1434–41

    Article  CAS  PubMed  Google Scholar 

  10. Lilly USA. Highlights of prescribing information [online]. Available from URL: http://pi.lilly.com [Accessed 2012 Apr 1]

  11. Hodsman AB, Bauer DC, Dempster DW, et al. Parathyroid hormone and teriparatide for the treatment of osteoporosis: a review of the evidence and suggested guidelines for its use. Endocr Rev 2005; 26: 688–703

    Article  CAS  PubMed  Google Scholar 

  12. Shiraki M, Fukunaga M, Kushida K, et al. A double-blind dose-ranging study of risedronate in Japanese patients with osteoporosis. Osteoporos Int 2003; 14: 225–34

    CAS  PubMed  Google Scholar 

  13. Kishimoto H, Fukunaga M, Kushida et al. Efficacy and tolerability of once-weekly administration of 17.5mg risedronate in Japanese patients with involutional osteoporosis: a comparison with 2.5-mg once-daily dosage regimen. J Bone Miner Metab 2006; 24: 405–13

    Article  CAS  PubMed  Google Scholar 

  14. Yoneda T, Hagino H, Sugimoto T, et al. Bisphosphonate-related osteonecrosis of the jaw: position paper from the Allied Task Force Committee of Japanese Society for Bone and Mineral Research, Japan Osteoporosis Society, Japanese Society of Periodontology, Japanese Society for Oral and Maxillofacial Radiology, and Japanese Society of Oral and Maxillofacial Surgeons. J Bone Miner Metab 2010; 28: 365–83

    Article  CAS  PubMed  Google Scholar 

  15. Orimo H, Sugioka Y, Fukunaga M, et al. Diagnostic criteria of primary osteoporosis. J Bone Miner Metab 1998; 16: 139–50

    Article  Google Scholar 

  16. Orimo H, Hayashi Y, Fukunaga M, et al. Diagnostic criteria for primary osteoporosis: year 2000 revision. J Bone Miner Metab 2001; 19: 331–7

    Article  CAS  PubMed  Google Scholar 

  17. Orimo H. Japanese guideline for prevention and treatment of osteoporosis: II. Diagnosis of osteoporosis [in Japanese]. Life Science 2011: pp. 16–17

  18. Miyauchi A, Matsumoto T, Sugimoto T, et al. Effects of teriparatide on bone mineral density and bone turnover markers in Japanese subjects with osteoporosis at high risk of fracture in a 24-month clinical study: 12-month, randomized, placebo-controlled, double-blind and 12-month open-label phases. Bone 2010; 47: 493–502

    Article  CAS  PubMed  Google Scholar 

  19. Galluzzo S, Santini D, Vincenzi et al. Immunomodulating role of bisphosphonates on human gamma delta T cells: an intriguing and promising aspect of their antitumour activity. Expert Opin Ther Targets 2007; 11: 941–54

    Article  CAS  PubMed  Google Scholar 

  20. Tsujimoto M, Chen P, Miyauchi A, et al. PINP as an aid for monitoring patients treated with teriparatide. Bone 2011; 48: 798–803

    Article  CAS  PubMed  Google Scholar 

  21. Lim SK, Kung AW, Sompongse S, et al. Vitamin D inadequacy in postmenopausal women in Eastern Asia. Curr Med Res Opin 2008; 24: 99–106

    Article  CAS  PubMed  Google Scholar 

  22. Iwamoto J, Takeda T, Matsumoto H. Sunlight exposure is important for preventing hip fractures in patients with Alzheimer’s disease, Parkinson’s disease, or stroke. Acta Neurol Scand 2011. Epub

  23. Sato Y, Metoki N, Iwamoto J, et al. Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in stroke patients. Neurology 2003; 61: 338–42

    Article  CAS  PubMed  Google Scholar 

  24. Sato Y, Iwamoto J, Kanoko T, et al. Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in hospitalized, elderly women with Alzheimer’s disease: a randomized controlled trial. J Bone Miner Res 2005; 20: 1327–33

    Article  CAS  PubMed  Google Scholar 

  25. Sato Y, Iwamoto J, Honda Y. Amelioration of osteoporosis and hypovitaminosis D by sunlight exposure in Parkinson’s disease. Parkinsonism Relat Disord 2011; 17: 22–6

    Article  PubMed  Google Scholar 

  26. Dawson-Hughes B, Chen P, Krege JH. Response to teriparatide in patients with baseline 25-hydroxyvitamin D insufficiency or sufficiency. J Clin Endocrinol Metab 2007; 92: 4630–6

    Article  CAS  PubMed  Google Scholar 

  27. Lindsay R, Scheele WH, Neer R, et al. Sustained vertebral fracture risk reduction after withdrawal of teriparatide in postmenopausal women with osteoporosis. Arch Intern Med 2004; 164: 2024–30

    Article  PubMed  Google Scholar 

  28. Prince R, Sipos A, Hossain A, et al. Sustained nonvertebral fragility fracture risk reduction after discontinuation of teriparatide treatment. J Bone Miner Res 2005; 20: 1507–13

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Jun Iwamoto & Hideo Matsumoto

  2. Department of Dentistry and Oral Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan

    Kaori Yago

  3. Department of Neurology, Mitate Hospital, Fukuoka, Japan

    Yoshihiro Sato

Authors
  1. Jun Iwamoto
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  2. Kaori Yago
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  3. Yoshihiro Sato
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  4. Hideo Matsumoto
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Correspondence to Jun Iwamoto.

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Iwamoto, J., Yago, K., Sato, Y. et al. Teriparatide Therapy for Bisphosphonate-Associated Osteonecrosis of the Jaw in an Elderly Japanese Woman with Severe Osteoporosis. Clin Drug Invest 32, 547–553 (2012). https://doi.org/10.1007/BF03261908

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  • DOI: https://doi.org/10.1007/BF03261908

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