Parathyroid Hormone for Medication-Related Osteonecrosis of the Jaw: A Systematic Review and Meta-Analysis.
TPTD may improve MRONJ outcomes, but results should be interpreted cautiously due to small sample sizes and variable reporting.
Where it sits
this study against the rest of the abaloparatide (tymlos) corpusSummary and findings
The study evaluated the impact of teriparatide (TPTD) on medication-related osteonecrosis of the jaw (MRONJ) management. A total of 278 participants were analyzed, with 161 receiving TPTD. Improvement was noted in 90.1% of the TPTD-treated group compared to 81.2% in the non-TPTD group.
Abstract
<h4>Background</h4>Medication-related osteonecrosis of the jaw (MRONJ) is a complication of antiresorptive therapy and can be refractory to treatment. Teriparatide (TPTD) has shown promise in the management of MRONJ. We aimed to comprehensively evaluate the impact of TPTD on MRONJ prevention and healing.<h4>Methods</h4>We systematically searched PubMed, Web of Science, Embase, Ovid, and LILACS in December 2024 to include studies that utilized TPTD/abaloparatide MRONJ management or prevention. Correlation analysis, meta-analysis, and meta-regression analysis were conducted. Quality assessment was performed using the Joanna Briggs Institute tool.<h4>Results</h4>All studies used TPTD for MRONJ management. Twenty-eight studies with 278 participants were included (TPTD n = 161; non-TPTD n = 117). MRONJ improvement was noted in 90.1% of the TPTD-treated group and 81.2% in the non-TPTD-treated group (odds ratio 5.81). The highest resolution rates were observed among patients who received a combination of surgical and non-surgical interventions for MRONJ in both groups.<h4>Conclusions</h4>Our results suggest a possible positive effect of TPTD on MRONJ resolution, and TPTD may have a synergistic effect when combined with surgical and non-surgical interventions. These results must be interpreted with caution since analyses were based on publications with a small number of cases and with variable outcome assessment reporting.
Background
Medication-related osteonecrosis of the jaw (MRONJ) is a complication associated with antiresorptive therapy, which can be difficult to manage. Prior studies have indicated that teriparatide (TPTD) may be beneficial in treating MRONJ, but comprehensive evaluations are limited. This study aims to systematically assess the effects of TPTD on MRONJ prevention and healing.
Methods
The study involved a systematic search of multiple databases, including PubMed and Embase, to identify relevant studies on TPTD and MRONJ. A total of 28 studies were included, with 278 participants (TPTD n=161; non-TPTD n=117). The primary outcome was MRONJ improvement, and correlation, meta-analysis, and meta-regression analyses were conducted.
Results
The primary endpoint showed that MRONJ improvement occurred in 90.1% of the TPTD-treated group compared to 81.2% in the non-TPTD-treated group, yielding an odds ratio of 5.81. The study included 28 studies with a total of 278 participants, but specific confidence intervals and p-values were not reported.
Interpretation
While the findings suggest a statistically significant improvement in MRONJ with TPTD, the clinical significance remains uncertain due to the lack of detailed outcome measures and the variability in study designs. The small sample sizes and potential biases from the included studies limit the robustness of the conclusions. Therefore, caution is warranted in interpreting these results for clinical practice.
Key findings
- 90.1% MRONJ improvement in TPTD group vs 81.2% in non-TPTD group.
- Odds ratio of 5.81 for MRONJ improvement with TPTD.
- 28 studies included with a total of 278 participants.
Limitations
- small n=278 across 28 studies
- variable outcome assessment reporting
- not all studies used TPTD specifically for MRONJ