Indiana University School of Dentistry, Indianapolis, IN; and.
Department of Dentistry, Sri Aurobindo Institute of Medical Sciences, Indore, India.
Am J Ther. 2020 Jun 22;28(4):e469-e477. doi: 10.1097/MJT.0000000000001182.
Medication-related osteonecrosis of the jaw (MRONJ) is a painful and intractable disease of the jaw that clinically presents as an area of ulceration with exposed necrotic bone. In severe cases, it can predispose to jaw fracture, skin fistula, or osteolysis extending beyond the region of the alveolar bone. No effective treatment has been established for this condition. Recently, teriparatide, a recombinant parathyroid hormone, and the only FDA-approved osteoanabolic drug for the treatment of glucocorticoid-induced osteoporosis, has been used for the treatment of MRONJ. We review the literature highlighting the effectiveness of teriparatide alone or as an adjunct in the treatment of MRONJ. Twenty publications met our selection criteria, comprising 54 patients with stage 2 or 3 MRONJ secondary to antiresorptive/antiangiogenic drugs. Trauma due to implant placement was the most common triggering factor for the development of MRONJ. Patients were treated with subcutaneous injections of 20-μg teriparatide for 3-12 months (5 1/2 months average). Symptomatic relief was achieved in almost all cases, with lesions healing completely in 49 of 54 patients. Based on our findings, teriparatide can play an important role in the treatment of MRONJ.
药物相关性颌骨坏死（MRONJ）是一种疼痛且难以治疗的颌骨疾病，临床上表现为溃疡伴暴露的坏死骨区域。在严重的情况下，它可能导致颌骨骨折、皮肤瘘管或骨溶解，超出牙槽骨区域。目前尚未针对这种情况确立有效的治疗方法。最近，特立帕肽，一种重组甲状旁腺激素，也是唯一被 FDA 批准用于治疗糖皮质激素诱导的骨质疏松症的骨合成代谢药物，已被用于治疗 MRONJ。我们回顾了文献，强调了特立帕肽单独或作为辅助治疗 MRONJ 的有效性。有 20 篇出版物符合我们的选择标准，包括 54 例因抗吸收/抗血管生成药物而导致 2 期或 3 期 MRONJ 的患者。因植入物放置引起的创伤是导致 MRONJ 发展的最常见触发因素。患者接受了皮下注射 20-μg 特立帕肽治疗 3-12 个月（平均 5.5 个月）。几乎所有病例都获得了症状缓解，54 例患者中有 49 例完全愈合。根据我们的发现，特立帕肽在治疗 MRONJ 中可以发挥重要作用。
