10/16/10 Two new studies suggest that the drug teriparatide, or Forteo, may help people who have lost bone in their jaw because of periodontal disease or osteonecrosis.
Periodontal disease is severe, chronic inflammation of the gums that is a major cause of tooth loss. It affects 1 in 5 American adults, and it is seen more frequently in people with rheumatoid arthritis, or RA, than in the general population.
Osteonecrosis is the death of bone tissue, and it can occur as a rare side effect related to the use of bisphosphonates, drugs used to treat cancer and osteoporosis..
Teriparatide is an injectable form of parathyroid hormone. It has been approved by the U.S. Food and Drug Administration for several years as a treatment for osteoporosis. Unlike medications that treat bone loss by stopping bone breakdown, however, teriparatide works by spurring the growth of new bone.
In the October 16th online issue of the New England Journal of Medicine, researchers from Melbourne, Australia present a case study of an 88-year-old woman who developed osteonecrosis of the jaw after taking the corticosteroid medication prednisolone for 20 years and the bisphosphonate drug alendronate, or Fosamax, for 10 years.
She developed jaw wounds and suffered from pain for a year before agreeing to try teripartide. After eight weeks, her symptoms disappeared, and her osteonecrosis resolved.
Researchers say teriparatide appears to have healed the bone by stimulating new growth. But they stress this has been shown only in a few patients so they say a randomized, controlled trial is needed for further proof.
“Osteonecrosis of the jaw has been difficult to treat, but we hypothesize that teriparatide may be a novel effective treatment, which requires further study,” says Dr. Ada Cheung, an endocrinologist at The University of Melbourne in Australia.
“If teriparatide was proven in a randomized controlled trial to heal osteonecrosis of the jaw, this would be a significant advance as there are currently no good treatments for osteonecrosis of the jaw," Dr. Cheung says. "Patients can have painful symptoms for years and often require multiple surgical procedures to clean the infected bone as well as prolonged courses of antibiotics."
A second study reported in the same journal tested teriparatide for the first time in the treatment of bone loss in the mouth caused by periodontal disease.
For several years I took Fosamax, then Boniva for almost five for osteopenia of hips and spine, usually showing more bone density decline with every annual density test. Now my latest test shows I have severe osteoporosis, with a 6% bone mass decline in the past year.
I'm 68, weigh 124, 5'3", have moderate scoliosis, and all the usual degenerative spinal conditions, spinalolesthesis, stenosis, etc. I control the pain with daily exercise and spinal epidurals, take lots of calcium+vitamin D, have well balanced diet including large variety of fruits and vegetables. No family history of osteoporosis. Love to be active. I refuse to accept the grim possibility of a crippled life of bone fractures without a good fight! Your comment?
My mother is 78 years old and she had a fracture on her L-1 about four months ago ,then she had surgery of vertebroplasty one month later ,two days after her surgery ,she had another fracture on her D11.
Bone densiometry report ,Whole body spect imaging report and related blood test results are as follows:
1- Bone densiometry report :
A bone mineral density (BMD)measurement was done on the mentioned patient.Dual energy X-ray Absorbtiometry (DXA technique)was used to determine the bone density of her AP spine and left hip by a Norland(EXEL)machine.Results are presented below.
Her spine BMD at L2-L4 area : 0.664g/cm2.
Compared to normal young adult Caucasians females (Norland reference )it is : 60% T- SCORE : -2.7
Compared to normal Caucasion females of the same age (Norland reference) it is : 75% Z-SCORE: - 1.3
Her hip BMD at femoral neck : 0.544g/cm2.
Compared to normal young adult Caucasians females (Norland reference ) it is : 55% T – SCORE : - 2.7
Compared to normal Caucasian females of the same age(Norland reference )it is : 82% Z – SCORE : - 1.0
INTERPRETATION:
Compared to young adult Caucasioan females and according to WHO,s criteria this study indicates very low bone density of the spine and hip.So the patient is classified as case of (OSTEOPOROSIS).
RISK FACTORS:
Caucasian.Menopause.
2-Whole Body Spect imaging( its time is before the second fracture)
Images were obtained 3 hrs. After I.V injection of 22 mci Medronate.
A notable finding is an intense uptake in the vertebral body of L1 that is better identified on 3D spect images. In addition there are multiple degenerative changes in the shoulders,knees,right shoulder and cervical spine.
IMPRESSION:
The whole body spect images in the vertebral body of L1 is infavour of active bone lesion or compression FX. X Ray correlation is recommended if clinically indicated.
3-Blood test results:
TEST RESULT REFERENCE(based
on sex/age)
PTH 19.2 pg/ml 7-82
Calcium 10.2mg/dl 8.6-10.3
Phosphorus 3.2mg/dl 2.5-4.5
Alkaline phosphatase 81 U/L 40-100
Prescribtion
Her physican has prescribed to her about 2 months ago the followings:
calsitonine nasal spray every night osteophos(alendronate sodium) 70 mg weekly calcium+vitaminD two tablet daily
Another physician has recently prescribed to her FORTEO injection instead of the above medicines.
MY QUESTIONS?
Due to the above you are kindly requested to let me know:
1- Should she inject forteo ampouls for 18 months as her treatment or take osteophos tablet weekly and calcinonine spray daily?
2- Doesn’t forteo have side –effect?
3- What is my mother’s main, real and right treatment ?
I am looking forward to hearing from you as soon as possible.
THANKS ,regards,ROYA SHOJAEI
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