Milsof BM, Paschalis EP, Blouin S, Fratzl- Zelman N, Klaushofer K, Roschger P. Effects of 1 year of daily teriparatide treatment on iliacal bone mineralization density distribution (BMDD) in postmenopausal osteoporotic women previously treated with alendronate or risedronate. J Bone Min Res. 2010;25:2297-2303.
Currently many of our dental implant patients are long-term users of oral bisphosphonates for the treatment/prevention of osteoporosis/osteopenia and therefore clinicians are faced with the question of how to treat these individuals. This article in JBMR offers insight into how the decreased rate of bone turnover induced by prolonged use of alendronate (Fosamax) or risedronate (Actonel) may be reversed with the use of daily teriparatide (Forteo) subcutaneous injections. Teriparatide possesses anabolic effects that increase bone formation by improving bone turnover and therefore is recommended as a second-line treatment for severe osteoporosis. Bisphosphonates are antiresorptive agents and therefore decrease bone turnover. This may be of significance when the implant dentist places bone grafts or dental implants.
This study evaluated the effects of sequential antiresorptive and anabolic treatment on bone mineralization density distribution (BMDD), and appraised the differences in the BMDD response to teriparatide in light of the previous bisphosphonate therapy. Paired transiliac bone biopsy samples taken before and after 1 year of treatment with teriparatide (recombinant human parathyroid hormone peptide 1-34) from 16 osteoporotic women treated with either alendronate or risedronate for at least 2 years previously. Cancellous and cortical BMDD values were measured. The authors concluded that teriparatide treatment altered the BMDD in a positive fashion in patients who had previously taken alendronate or risedronate. Additionally, there was no differential effect due to the type of prior bisphosphonate therapy in either cancellous or cortical BMDD.
The significance for the Implant Dentist is this may be a possible treatment option for our patients who present for implant therapy and have severely suppressed bone turnover (SSBT) due to prolonged bisphosphonate therapy. SSBT would be detected by examining the serum bone turnover makers CTX (C-terminal cross linked collagen peptide), NTX (N-terminal cross linked collagen peptide) and/or BSAP (Bone specific alkaline phosphatase).
James L Rutkowski DMD, PhD
Editor-in-Chief, Journal of Oral Implantology
Chairman, Clarion Research Group