Bisphosphonate-associated osteonecrosis of the jaw, with healing after teriparatide: a review of the literature and a case report

Spec Care Dentist. 2010 Mar-Apr;30(2):77-82. doi: 10.1111/j.1754-4505.2009.00128.x.


This paper reports the case history of a patient who had bisphosphonate-associated osteonecrosis of the jaw (ONJ) in which adjunctive treatment with teriparatide was used. The patient was treated for 5 years with alendronate for osteoporosis and developed ONJ after extraction of maxillary teeth. An implant was placed at the site of the extracted teeth. The pathology report confirmed the clinical diagnosis of ONJ; treatment was changed from alendronate to teriparatide and the ONJ resolved. To our knowledge, this is the third case history reported in the literature in which teriparatide was successfully used as adjunct therapy in ONJ because it has an anabolic effect and presumed role in accelerating bone healing. ONJ is a serious but infrequent condition that has been recently associated with nitrogen-containing bisphosphonate therapy. Teriparatide may be a useful adjunctive therapy when ONJ develops.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Alendronate / adverse effects
  • Bone Density Conservation Agents / administration & dosage
  • Bone Density Conservation Agents / adverse effects*
  • Bone Density Conservation Agents / therapeutic use
  • Bone Regeneration / drug effects
  • Dental Implants
  • Diphosphonates / adverse effects*
  • Follow-Up Studies
  • Humans
  • Injections, Subcutaneous
  • Male
  • Maxillary Diseases / chemically induced*
  • Maxillary Diseases / drug therapy
  • Middle Aged
  • Osteoarthritis / drug therapy
  • Osteonecrosis / chemically induced*
  • Osteonecrosis / drug therapy
  • Osteoporosis / drug therapy
  • Teriparatide / administration & dosage
  • Teriparatide / therapeutic use*
  • Tooth Extraction


  • Bone Density Conservation Agents
  • Dental Implants
  • Diphosphonates
  • Teriparatide
  • Alendronate