(41) A Study on the Treatment Period and Bone Turnover Markers According to Application of Teriparatide in the Treatment of Medication-related Osteonecrosis of the Jaw

Abstract: Statement of the problem
The administration of teriparatide(TPTD) shows good clinical outcomes in previously refractory medication-related osteonecrosis of the jaws(MRONJ). Bone turnover markers, factors involved in bone formation and resorption, are used to measure the activity of bone metabolism and are an important factor that assesses the onset of MRONJ and the prognosis for treatment.

Material and methods
In this study, we compared the difference in treatment duration, the number of surgical procedures, and the change in the bone turnover marker according to the application of teriparatide in MRONJ patients.
Seventy-six patients who were diagnosed with MRONJ and resolved after treatment were classified as conservative treatment and surgical treatment, the application of teriparatide. Patients’ MRONJ-related characteristics, duration of treatment, number of surgical procedures, and changes in bone turnover marker - serum C-terminal telopeptide cross-link of type 1 collagen(CTX), osteocalcin(OC), procollagen type 1 N-terminal propeptide(P1NP), parathyroid hormone(PTH), 25-OH-Vitamin D(25(OH)D), calcium and inorganic P - at the first visit and completion of treatment were measured.

Methods of data analysis
Clinical data were considered statistically significant when the p-value was less than 0.05.For statistical analysis, the program ‘IBM SPSS statistics ver.23 (IBM Co., Armonk, NY, USA)’ was used. Factors for each group were analyzed through Fisher's exact test, one-way ANOVA, and Kruskal-Wallis analysis.

Result
In the result, the rate of recovery by conservative treatment without surgical operation was higher in the maxilla than the mandible, and there was a statistically significant difference(p=0.006). In all groups, the total treatment period was shorter in the group that applied TPTD than that did not apply TPTD. But there was no statistically significant difference(p>0.05).
Outcomes Data
In the surgical group, the groups that applied TPTD has a shorter surgical treatment period than those that did not apply TPTD, and there was a statistically significant difference(p=0.03). In both the TPTD group and the Non-TPTD group, CTX, OC, and 25(OH)D level before and after treatment was significantly elevated, and higher in the TPTD group(p < 0.01). P1NP level increased in both groups, but only in the Non-TPTD group showed a statistically significant difference(p=0.012). PTH levels decreased in both groups, but there was no statistically significant difference. Ca and P levels increased in both groups, but only Ca levels in the TPTD group showed a statistically significant increase(p < 0.001).

Conclusions relevant to the problem
In conclusion, The application of TPTD in MRONJ treatment can shorten the treatment period during surgical treatment and is expected to act as an important factor in predicting the effect of MRONJ treatment by promoting the activity of bone metabolism

References
Anabtawi, M., Tweedale, H., & Mahmood, H. (2020). The role, efficacy, and outcome measures for teriparatide use in the management of medication-related osteonecrosis of the jaw. International journal of oral and maxillofacial surgery.
Jung, J., Yoo, H. Y., Kim, G. T., Lee, J. W., Lee, Y. A., Kim, D. Y., & Kwon, Y. D. (2017). Short‐term teriparatide and recombinant human bone morphogenetic protein‐2 for regenerative approach to medication‐related osteonecrosis of the jaw: a preliminary study. Journal of Bone and Mineral Research, 32(12), 2445-2452.