Department of Oral and Maxillofacial Surgery, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, Korea.
Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Osteoporos Int. 2018 Apr;29(4):987-992. doi: 10.1007/s00198-017-4343-2. Epub 2017 Dec 16.
Although osteoradionecrosis (ORN) is a serious complication of craniofacial radiotherapy, the current management methods remain suboptimal. Teriparatide (TPTD), a recombinant human parathyroid hormone (1-34), has shown beneficial effects on osseous regeneration in medication-related osteonecrosis of the jaw or periodontitis. However, TPTD therapy in irradiated bones has not been indicated yet because of the theoretical risk of osteosarcoma seen in rat models. Hence, we first report here two patients with tongue cancer with late-emerging ORN who were successfully treated with TPTD for 4-6 months with serum calcium and vitamin D supplementation. In contrast to the usual progress of ORN, the bone defect regenerated well and bone turnover markers including serum C-terminal telopeptide of type 1 collagen and osteocalcin were restored with TPTD therapy. Our experience might suggest that TPTD therapy with careful monitoring can provide an effective treatment option for patients with ORN in select refractory cases, with the benefits outweighing the potential risks.
尽管放射性骨坏死（ORN）是头颈部放疗的严重并发症，但目前的治疗方法仍不尽人意。特立帕肽（TPTD），一种重组人甲状旁腺激素（1-34），在药物相关性颌骨坏死或牙周炎的骨再生方面显示出有益的效果。然而，由于在大鼠模型中观察到理论上的骨肉瘤风险，TPTD 治疗在放射性骨中尚未得到指示。因此，我们首次在这里报告了 2 例晚期放射性骨坏死的舌癌患者，他们在接受特立帕肽治疗 4-6 个月并补充血清钙和维生素 D 后成功治疗。与 ORN 的通常进展相反，骨缺损再生良好，骨转换标志物，包括血清 1 型胶原 C 端肽和骨钙素，在用特立帕肽治疗后得到恢复。我们的经验可能表明，在选择难治性病例中，在仔细监测下使用特立帕肽治疗可为 ORN 患者提供有效的治疗选择，其益处大于潜在风险。
