PMC3706737_01
Case 1. An 87-year-old Japanese woman with a 4-year history of alendronate therapy. a At presentation, there were multiple fistulas with purulent discharge over the left maxillary ridge (arrowheads). After 3 months of conservative therapy, the unhealed wound was surgically debrided, and two teeth were extracted. b After 12 months of conservative treatment, there was still exposed bone in the upper jaw. c After 10 weeks of teriparatide treatment, the necrotic bone had healed, and there was complete soft tissue coverage of the intraoral wound. d, g Computed tomography (CT) images showing the maxilla before tooth extraction and debridement. e, h CT images after 1 year of conservative treatment, showing expansion of the BRONJ area. f, i CT images after 10 weeks teriparatide treatment, showing improvement of the maxillary sinusitis. j Levels of serum N-telopeptide of type I collagen (s-NTX) and serum N-terminal propeptide of type I collagen (P1NP)
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Fig1
Three months later, she underwent sequestrectomy and extraction of the maxillary left first and second molars because of high tooth mobility (Fig. 1a, d, g). However, her disease was persistent and progressive (Fig. 1b, e, h). Computed tomography showed that her maxillary sinusitis attributed to stage 3 BRONJ had resolved (Fig. 1c, f, i). Her s-NTX levels were slightly higher than the pretreatment level at 1 and 3 months after the initiation of TPTD treatment, and her serum P1NP level decreased after the initiation of TPTD treatment (Fig. 1j).
PMC3706737_02
Case 2. An 87-year-old Japanese woman with a 4-year history of alendronate therapy. a External view showing submental redness. b Intraoral view showing exposed bone after the teeth were lost. c CT image at presentation. d External view after 3 months of teriparatide treatment. e Intraoral view after 2 months of teriparatide treatment, showing that the necrotic bone has healed and the defect is covered with normal mucosa. f CT image after 3 months of teriparatide treatment. g Levels of serum N-telopeptide of type I collagen (s-NTX) and serum N-terminal propeptide of type I collagen (P1NP)
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Fig2
She had infection of both the bone and soft tissues (Fig. 2a, b, c). Computed tomography showed partial healing of the mandibular fracture (Fig. 2d, e, f). Her s-NTX levels were slightly increased compared with the pretreatment level at 2 and 4 months after the initiation of TPTD treatment, and her serum P1NP level was significantly increased at 2 months after the initiation of TPTD treatment (Fig. 2g).