Type of publication:
*Chundoo S.; *Pilkington R.; *Bhatia S.; *Garton M.
British Journal of Oral and Maxillofacial Surgery; Dec 2019; vol. 57 (no. 10)
Introduction: Case presentation of 61 year old female patient who developed BRONJ (bisphosphonate related osteonecrosis of the jaw) and a pathological triple fracture of the anterior mandible. She had underlying vitamin D deficiency and secondary hypoparathyroidism. She also suffers from anca positive rheumatoid arthritis and is under the active care of rheumatology.
Method(s): Patient was treated with conservative measures which failed to give a good quality of life outcome. Under special license, with involvement from rheumatology, the patient was started on monthly injections of recombinant parathyroid hormone (teriparatide).
Result(s): Over 12-18 months, the serial radiographs reveal bony union of all fracture sites. Patient now has
good quality of life and patient is back on disease modifying drugs to control their active rheumatoid arthritis.
Conclusions/Clinical Relevance: Novel approach to using teriparatide for patients with end-stage BRONJ.
License of the drug as well as current NICE guidelines for its use and patient specific requirements such as
fragility fracture risks age and DEXA scores are also discussed. The action of the drug on osteoblastic formation and bone turnover is discussed. This will help practitioners have another agent to add to their treatment options in treating the effects of BRONJ.