Clinical Outcomes of Medication-Related Osteonecrosis of the Jaw After Switching From Antiresorptive Agents to Teriparatide

Background and aimTeriparatide (TPTD) is an anabolic agent that promotes bone formation, and its potential utility as an adjunctive treatment for medication-related osteonecrosis of the jaw (MRONJ) has been reported.This study aimed to investigate the clinical characteristics and treatment outcomes of patients with MRONJ who were switched from antiresorptive agents to TPTD. MethodsWe retrospectively reviewed patients with MRONJ seen between April 2020 and March 2025 whose underlying disease treatment was switched from an antiresorptive agent to TPTD.The primary outcome was MRONJ status at the final follow-up visit, classified as favorable (improved or healed) or unfavorable (unchanged or worsened).The overall descriptive analysis included 15 patients; exploratory association analyses were restricted to the 11 patients who continued or completed TPTD treatment. ResultsFifteen patients were included (1 male and 14 females), with a mean age of 78.9 ± 7.1 years (range, 62-94 years).The underlying diseases were osteoporosis in 12 patients and rheumatoid arthritis in three patients.The MRONJ stages at the initial visit were Stage 1 in three patients, Stage 2 in seven, and Stage 3 in five.The lesions were located in the maxilla in two patients and the mandible in 13.TPTD was administered daily in seven patients and once weekly in eight.MRONJ treatment consisted of conservative therapy in seven patients and surgical treatment in eight.Favorable clinical outcomes were observed in 12 of 15 patients (80.0%; 95% CI, 51.9-95.7%),including complete healing in four patients (26.7%).However, individual follow-up durations could not be reliably determined from the available retrospective records, and outcomes were assessed at the last documented clinical evaluation rather than at a standardized time point.No statistically significant association was observed between any evaluated clinical factor and treatment outcome. ConclusionsFavorable clinical outcomes were observed in 12 of 15 patients (80.0%), including complete healing in four patients (26.7%).However, because of the small sample size, absence of a control group, and concomitant conservative or surgical interventions, these findings do not establish an independent therapeutic effect of TPTD.Further controlled studies are warranted.