Use of Teriparatide for the Treatment of MRONJ in Non-Cancer Patients Refractory to the Traditional Conservative Therapy: A Systematic Review

Teriparatide (TPTD) is the synthetic analogue of ParaThyroid Hormone (PTH) commonly used for the treatment of osteoporosis in place of Bisphosphonates. In 2007 it was proposed also for the treatment of Medication Related Osteonecrosis of the Jaws (MRONJ) in non cancer patient. However, nowadays TPTD is still off-label in these patients, because of the lack of the scientific evidence of its safety and efficacy. We propose a Systematic Review of clinical reports dealing with the use of TPTD in non-oncological patients with refractory MRONJ. Using Pubmed as research engine, we researched and included only Case Reports or Case Series dealing with the use of TPTD in non cancer patients with MRONJ (Eligibility Criterion). We excluded all experimental studies on animals and laboratory work conducted in vitro (Exclusion Criterion). We found 23 papers, published from February 2007 to May 2020, with the eligibility criteria established. A total of 97 patients have been included in our analysis, 86 women (88.7%) and 11 men (11.3%), age 52-88 years old (mean 77 y.o.). Most of them, 86.6% (84 out 97) were classified as positive outcome, while the 13.4% (13 out 97) as negative outcome. Although further randomized clinical trials are needed, TPTD seems to represent a valid support to surgery for the treatment of non oncological patients affected by MRONJ in advanced stage.