Short-Term Teriparatide and Recombinant Human Bone Morphogenetic Protein-2 for Regenerative Approach to Medication-Related Osteonecrosis of the Jaw: A Preliminary Study

J Bone Miner Res. 2017 Dec;32(12):2445-2452. doi: 10.1002/jbmr.3237. Epub 2017 Sep 18.


Our objective was to examine whether adjunct teriparatide administration and local application of recombinant human bone morphogenetic protein-2 (rhBMP-2) is beneficial for the regeneration of jaw bone in patients with medication-related osteonecrosis of the jaw (MRONJ). This study enrolled 17 patients diagnosed with MRONJ. All patients received sequestrectomy under general or local anesthesia with suspension of bisphosphonate. The bone regeneration ratio was compared on cone beam computed tomography (CBCT) scans, acquired immediately post-operation and after 6 months. The patients were divided into groups, based on their treatment regimens: teriparatide combined with rhBMP-2 (parathyroid hormone [PTH]+BMP), rhBMP-2 (BMP), and the control. Biochemical markers were also evaluated at the baseline (T0), 1 month (T1), and 3 months (T2) after surgery. Significant increase was observed in the values of the biochemical markers, serum osteocalcin, and serum C-terminal telopeptide cross-link of type I collagen, within 3 months of surgery in the PTH+BMP group, whereas the mean value in the BMP group did not show a significant change. In all groups, the MRONJ lesions were healed and new bone formation was detected in the CBCT images. The regeneration ratio was significantly greater in the group PTH+BMP than in the BMP and control groups. Significantly greater amount of bone formation was observed in the group PTH+BMP than in the BMP and control groups. Local application of rhBMP-2 alone also had a beneficial effect on bone regeneration but was not more significant than control. Based on these findings, administration of short-term teriparatide with rhBMP-2 in MRONJ patients may maximize the regeneration of bone after surgery. © 2017 American Society for Bone and Mineral Research.


Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / metabolism
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / blood
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / diagnostic imaging
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / drug therapy*
  • Bone Morphogenetic Protein 2 / pharmacology
  • Bone Morphogenetic Protein 2 / therapeutic use*
  • Bone Regeneration* / drug effects
  • Bone Remodeling / drug effects
  • Collagen Type I / blood
  • Demography
  • Female
  • Humans
  • Male
  • Middle Aged
  • Osteocalcin / blood
  • Peptides / blood
  • Recombinant Proteins / pharmacology
  • Recombinant Proteins / therapeutic use
  • Teriparatide / pharmacology
  • Teriparatide / therapeutic use*
  • Transforming Growth Factor beta / pharmacology
  • Transforming Growth Factor beta / therapeutic use*


  • Biomarkers
  • Bone Morphogenetic Protein 2
  • Collagen Type I
  • Peptides
  • Recombinant Proteins
  • Transforming Growth Factor beta
  • collagen type I trimeric cross-linked peptide
  • recombinant human bone morphogenetic protein-2
  • Osteocalcin
  • Teriparatide