Restoring skeletal remodeling in antiresorptive-treated patients: clinical outcomes of teriparatide in medication-related osteonecrosis of the jaw
5 affiliations
- 1Oral and Maxillofacial Surgery Postgraduate Program, Universidad Nacional de Colombia, Bogotá, Colombia
- 2Fundación Santa Fe de Bogotá, Bogotá, Colombia
- 3Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia
- 4Biomedical Engineering Department, Universidad de los Andes, Bogotá, Colombia
- 5School of Dentistry, Universidad Nacional de Colombia, Bogotá, Colombia
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a challenging complication associated with antiresorptive and antiangiogenic therapies. Prolonged suppression of bone remodeling has been implicated as a key mechanism in its pathophysiology. Teriparatide, an osteoanabolic agent that restores coupled bone remodeling, has been proposed as a potential therapeutic strategy. This review aimed to synthesize reported clinical outcomes of teriparatide use in MRONJ within a systemic remodeling-based framework. We conducted a structured descriptive review based on a systematic literature search and reported in accordance with PRISMA 2020. Studies reporting therapeutic use of teriparatide in established MRONJ were included regardless of the triggering medication. Data were extracted on patient characteristics, MRONJ stage, lesion site, antiresorptive exposure, teriparatide regimen, antiresorptive interruption, antiresorptive type, and clinical outcomes. Because of substantial heterogeneity in study design, patient populations, co-interventions, and outcome reporting, evidence was synthesized qualitatively. Thirty-four publications including 207 patients were included. Clinical outcomes were available for 201 patients: complete coverage/healing was reported in 163, partial improvement in 24, no change in 12, and worsening in 2. Teriparatide discontinuation or dropout after treatment initiation was reported in 13 patients. Stage 2 disease predominated among stageable cases, mandibular involvement was the most frequent anatomical site, and daily teriparatide dosing was more commonly reported than weekly regimens. Bisphosphonate exposure predominated, whereas denosumab-associated cases were fewer; therefore, differential effectiveness by antiresorptive class could not be determined. Published reports describe frequent clinical improvement after teriparatide use in MRONJ. However, the evidence remains descriptive, heterogeneous, and commonly confounded by concomitant therapies. These findings support a biologically plausible remodeling-based interpretation but do not establish efficacy or define teriparatide as standard therapy.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00198-026-08150-y.
Related
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BibTeX
@article{lievano2026restoring,
title = {{Restoring skeletal remodeling in antiresorptive-treated patients: clinical outcomes of teriparatide in medication-related osteonecrosis of the jaw}},
author = {Ana Karina Sarmiento Liévano and Hannah Vanessa Ceballos Sarmiento and Nicolás Jiménez Vega and Yeisson Alejandro Arias Avila and Maria Paula Monroy Becerra},
journal = {Osteoporosis International},
year = {2026},
month = aug,
doi = {10.1007/s00198-026-08150-y},
url = {https://doi.org/10.1007/s00198-026-08150-y},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Restoring skeletal remodeling in antiresorptive-treated patients: clinical outcomes of teriparatide in medication-related osteonecrosis of the jaw
AU - Ana Karina Sarmiento Liévano
AU - Hannah Vanessa Ceballos Sarmiento
AU - Nicolás Jiménez Vega
AU - Yeisson Alejandro Arias Avila
AU - Maria Paula Monroy Becerra
PY - 2026
DA - 2026/08/19
JO - Osteoporosis International
DO - 10.1007/s00198-026-08150-y
UR - https://doi.org/10.1007/s00198-026-08150-y
AB - Medication-related osteonecrosis of the jaw (MRONJ) is a challenging complication associated with antiresorptive and antiangiogenic therapies. Prolonged suppression of bone remodeling has been implicated as a key mechanism in its pathophysiology. Teriparatide, an osteoanabolic agent that restores coupled bone remodeling, has been proposed as a potential therapeutic strategy. This review aimed to synthesize reported clinical outcomes of teriparatide use in MRONJ within a systemic remodeling-based framework. We conducted a structured descriptive review based on a systematic literature search and reported in accordance with PRISMA 2020. Studies reporting therapeutic use of teriparatide in established MRONJ were included regardless of the triggering medication. Data were extracted on patient characteristics, MRONJ stage, lesion site, antiresorptive exposure, teriparatide regimen, antiresorptive interruption, antiresorptive type, and clinical outcomes. Because of substantial heterogeneity in study design, patient populations, co-interventions, and outcome reporting, evidence was synthesized qualitatively. Thirty-four publications including 207 patients were included. Clinical outcomes were available for 201 patients: complete coverage/healing was reported in 163, partial improvement in 24, no change in 12, and worsening in 2. Teriparatide discontinuation or dropout after treatment initiation was reported in 13 patients. Stage 2 disease predominated among stageable cases, mandibular involvement was the most frequent anatomical site, and daily teriparatide dosing was more commonly reported than weekly regimens. Bisphosphonate exposure predominated, whereas denosumab-associated cases were fewer; therefore, differential effectiveness by antiresorptive class could not be determined. Published reports describe frequent clinical improvement after teriparatide use in MRONJ. However, the evidence remains descriptive, heterogeneous, and commonly confounded by concomitant therapies. These findings support a biologically plausible remodeling-based interpretation but do not establish efficacy or define teriparatide as standard therapy. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00198-026-08150-y.
SN - 0937-941X
SN - 1433-2965
ER -