We all must know by now that Forteo ® (teriparatide) is the only osteoporosis drug that slows bone resorption (bone loss) and accelerates bone formation (growth). For this reason, it seems like a natural assumption that it could be used for types of bone loss other than osteoporosis. One of these types of bone loss occurs as we age in our jaw bones. This loss can be from osteoporosis or things like periodontal disease, a common inflammatory condition of the oral cavity. When periodontal disease develops, one treatment option is to perform a bone graft surgery to strengthen the jaw bone around the affected teeth. Because periodontal disease can impeded healing and bone growth in these situations, Forteo has been tested in a small study to see if it would stimulate wound healing and bone growth after these types of surgeries. The results of this study have been very encouraging in that the Forteo, given for 6 weeks, help to stimulate bone growth and wound healing. This information was announced by the ASBMR annual meeting from the Michigan Center for Oral Health Research at the University of Michigan in Ann Arbor, and published by the New England Journal of Medicine on October 16, 2010.
Forteo (teriparatide) is a man-made version, which consists of 34 amino-acids of our parathyroid hormone. Forteo is given via a sub-cutaneous injection into the abdomen or thigh for 2 years for osteoporosis, and in this study for periodontal surgery, 6 weeks.
In this study 40 patients with severe periodontal disease received either 20 micrograms of Forteo or a placebo daily, plus 1,000 milligrams of calcium, 800 International Units of vitamin D for 6 weeks after their surgery. The patients involved in this study gave themselves the Forteo/placebo injections daily, starting 3 days prior to surgery. At the end of the study “treatment with teriparatide was associated with greater radiographic resolution of alveolar bone loss and more marked improvements in clinical measures of disease activity during 1 year of follow-up .” This treatment induced bone growth and wound healing was beyond what was expected and occurred in a shorter length of time. This shows us that Forteo can be used with great success for other applications of enhanced bone growth, but it will be some time before it’s approved for this use.
Forteo’s Multiple Uses
We also know how Forteo stimulates fracture healing in the pelvic bone, and clinical trials done on this very topic were successful. For those who had slow-healing pelvic fractures Forteo helped to reduce pain and accelerate healing of this area of the body. Forteo is also used for those with spontaneous femur fractures that occurred from bisphosphonate use, after the patient has had the fracture surgically repaired. In some cases those who’ve used bisphosphonates, and had a subsequent femur fracture used Forteo for a short time to help stimulate fracture repair. Another side effect of bisphosphonates is osteonecrosis of the jaw, a debilitating condition with minimal resources for treatment. “Cheung and Seeman report the case of an elderly woman, who had taken alendronate (Fosamax ®) for 10 years for the treatment of glucocorticoid-induced osteoporosis, who presented with osteonecrosis of the jaw. The condition failed to respond to standard therapy, which typically includes cautious dÃ©bridement, the use of antiseptic mouthwashes, and treatment with antibiotics. After treatment with teriparatide for 8 weeks, the osteonecrosis of the jaw was healed, and there was impressive resolution of the mandibular osseous defect .”
Due to the efficacy of this drug in many bone growth situations, researchers are also looking at using it for dental implant procedures to help grow bone, and hasten healing around the newly implanted tooth.
This is great news for those who need to have oral bone graft surgery, dental implants, treatment of bisphosphonate induced osteonecrosis of the jaw and bone fracture repair from bisphosphonate use.
New England Journal of Medicine (2010, October 16).Teriparatide for Bone Loss in the Jaw. NEJM. Retrieved November 29, 2010 from http://www.nejm.org/doi/full/10.1056/NEJMe1010459