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Ebrahimi S, Navabazam A, Salemi F, Khaleghi F, Barzegar M, Saghafi F, Fallahzadeh H. The efficacy of teriparatide (Cinnopar®) on bone repair in mandibular fractures: A single blinded randomized clinical trial. J Craniomaxillofac Surg 2022; 50:923-928. [PMID: 36646571 DOI: 10.1016/j.jcms.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 12/12/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023] Open
Abstract
This study focused on the effects of teriparatide (CinnoPar) on healing and postoperative complications in mandibular bone fractures. In this single-blind randomized controlled trial, 30 patients with a mandibular fracture hospitalized for open reduction internal fixation were randomly assigned to the intervention (I) (n = 15) and control (C) (n = 15) groups. Both groups received daily acetaminophen and cephalexin for 1 week. For 1 month, Group I received daily subcutaneous teriparatide injections. The Radiographic Union Scale of the Mandible (RUSM) was used to assess mandibular bone fusion subjectively, and the Hounsfield unit (HU) was used to objectively assess radiodensity in a computed tomography (CT) scan. In both groups, the visual analog scale (VAS) score was used to assess postoperative complications such as pain, swelling, wound opening, pus secretion, and bitter taste. There was no significant difference in bone repair between the two groups in this study (P > 0.05). Teriparatide also had no effect on the postoperative complication rate in the control group (P > 0.05). Within the limitations of the study it seems that in mandibular fractures, teriparatide did not affect bone fusion or postoperative complications, so its use is not recommended for better bone fusion and fewer postoperative complications of mandibular fracture during the first month.
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Affiliation(s)
- Somayyeh Ebrahimi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, 8914815667, Iran.
| | - Alireza Navabazam
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, 8914815667, Iran.
| | - Fateme Salemi
- Islamic Azad University of Medical Sciences, School of Medicine, Yazd, 19395/1495, Iran.
| | - Fatemeh Khaleghi
- Department of Radiology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, 8916978477, Iran
| | - Mohsen Barzegar
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, 8914815667, Iran.
| | - Fatemeh Saghafi
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, 8915173149, Iran.
| | - Hossien Fallahzadeh
- Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, 8915173160, Iran
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Yan R, Jiang R, Hu L, Deng Y, Wen J, Jiang X. Establishment and assessment of rodent models of medication-related osteonecrosis of the jaw (MRONJ). Int J Oral Sci 2022; 14:41. [PMID: 35948539 PMCID: PMC9365764 DOI: 10.1038/s41368-022-00182-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/26/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is primarily associated with administering antiresorptive or antiangiogenic drugs. Despite significant research on MRONJ, its pathogenesis and effective treatments are still not fully understood. Animal models can be used to simulate the pathophysiological features of MRONJ, serving as standardized in vivo experimental platforms to explore the pathogenesis and therapies of MRONJ. Rodent models exhibit excellent effectiveness and high reproducibility in mimicking human MRONJ, but classical methods cannot achieve a complete replica of the pathogenesis of MRONJ. Modified rodent models have been reported with improvements for better mimicking of MRONJ onset in clinic. This review summarizes representative classical and modified rodent models of MRONJ created through various combinations of systemic drug induction and local stimulation and discusses their effectiveness and efficiency. Currently, there is a lack of a unified assessment system for MRONJ models, which hinders a standard definition of MRONJ-like lesions in rodents. Therefore, this review comprehensively summarizes assessment systems based on published peer-review articles, including new approaches in gross observation, histological assessments, radiographic assessments, and serological assessments. This review can serve as a reference for model establishment and evaluation in future preclinical studies on MRONJ.
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Affiliation(s)
- Ran Yan
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, Shanghai, China
| | - Ruixue Jiang
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, Shanghai, China
| | - Longwei Hu
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, Shanghai, China.,Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuwei Deng
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, Shanghai, China
| | - Jin Wen
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China. .,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China. .,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, Shanghai, China.
| | - Xinquan Jiang
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China. .,College of Stomatology, Shanghai Jiao Tong University, Shanghai, China. .,National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Engineering Research Center of Advanced Dental Technology and Materials, Shanghai, China.
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Xu X, Hui W, Liu N, Zhang Y. Effects of ergosteroside combined risedronate on fracture healing and BMP-2, BMP-7 and VEGF expression in rats. Acta Cir Bras 2021; 36:e361107. [PMID: 34932671 PMCID: PMC8691146 DOI: 10.1590/acb361107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/29/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose To evaluate the effect of ergosterol combined with risedronate on fracture
healing. Methods Sixty male Sprague Dawley fracture model rats were assigned into group A
(n=20), group B (n=20), and group C (n=20) at random. All rats were fed by
gavage until their sacrifice as it follows: group A with ergosteroside and
risedronate, group B with risedronate, and group C with saline solution. At
weeks 2 and 4, 10 rats of each group were sacrificed. Healing effect and
bone tissue changes in the fractures site were assessed by using hematoxylin
and eosin stain histology. Enzyme-linked immunosorbent assay was used to
detect the expression of serum bone morphogenetic protein-2 (BMP-2), bone
morphogenetic protein-7 (BMP-7), and vascular endothelial growth factor
(VEGF). Reverse transcriptase polymerase chain reaction was applied to
detect the expression of osteoprotegerin (OPG) mRNA, osteocalcin (OCN) mRNA
and core-binding factor subunit-?1 (CBF-?1) mRNA. Results In terms of serum BMP-2, BMP-7, and VEGF expression at weeks 2 and 4 after
gavage, group A < group B < group C (P<0.05). At week 4 after
gavage, serum VEGF expression in the three groups harbored positive
relationship with serum BMP-2 and BMP-7 expression (P<0.05). Regarding
serum OPG, OCN and CBF-?1 mRNA expression at weeks 2 and 4 after gavage,
group A <group B <group C (P<0.05). Hematoxylin and eosin staining
results showed that the recovery effect of trabecular bone and callus in the
cases of group A was better than the other two groups after intragastric
administration. Conclusion Ergosteroside combined risedronate can patently ameliorate the healing effect
of fracture in rats.
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Affiliation(s)
- Xiaofeng Xu
- Shanghai Jiao Tong University School of Medicine, China
| | - Wenyu Hui
- Shanghai Jiao Tong University School of Medicine, China
| | - Nian Liu
- Shanghai Jiao Tong University School of Medicine, China
| | - Yong Zhang
- Shanghai Jiao Tong University School of Medicine, China
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Aguirre JI, Castillo EJ, Kimmel DB. Preclinical models of medication-related osteonecrosis of the jaw (MRONJ). Bone 2021; 153:116184. [PMID: 34520898 PMCID: PMC8743993 DOI: 10.1016/j.bone.2021.116184] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/15/2021] [Accepted: 09/07/2021] [Indexed: 01/20/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe adverse event affecting patients with cancer and patients with osteoporosis who have been treated with powerful antiresorptives (pARs) or angiogenesis inhibitors (AgIs). pARs, including nitrogen-containing bisphosphonates (N-BPs; e.g., zoledronic acid, alendronate) and anti-RANKL antibodies (e.g., denosumab), are used to manage bone metastases in patients with cancer or to prevent fragility fractures in patients with osteoporosis. Though significant advances have been made in understanding MRONJ, its pathophysiology is still not fully elucidated. Multiple species have been used in preclinical MRONJ research, including the rat, mouse, rice rat, rabbit, dog, sheep, and pig. Animal research has contributed immensely to advancing the MRONJ field, particularly, but not limited to, in developing models and investigating risk factors that were first observed in humans. MRONJ models have been developed using clinically relevant doses of systemic risk factors, like N-BPs, anti-RANKL antibodies, or AgIs. Specific local oral risk factors first noted in humans, including tooth extraction and inflammatory dental disease (e.g., periodontitis, periapical infection, etc.), were then added. Research in rodents, particularly the rat, and, to some extent, the mouse, across multiple laboratories, has contributed to establishing multiple relevant and complementary preclinical models. Models in larger species produced accurate clinical and histopathologic outcomes suggesting a potential role for confirming specific crucial findings from rodent research. We view the current state of animal models for MRONJ as good. The rodent models are now reliable enough to produce large numbers of MRONJ cases that could be applied in experiments testing treatment modalities. The course of MRONJ, including stage 0 MRONJ, is characterized well enough that basic studies of the molecular or enzyme-level findings in different MRONJ stages are possible. This review provides a current overview of the existing models of MRONJ, their more significant features and findings, and important instances of their application in preclinical research.
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Affiliation(s)
- J I Aguirre
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - E J Castillo
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America.
| | - D B Kimmel
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL, United States of America
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Yoshiga D, Yoshioka I, Habu M, Sasaguri M, Tominaga K. Effective ancillary role and long-term course of daily or weekly teriparatide treatment on refractory medication-related osteonecrosis of the jaw: a clinical case series. Br J Oral Maxillofac Surg 2021; 60:604-609. [PMID: 34996629 DOI: 10.1016/j.bjoms.2021.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe adverse side effect of antiresorptive agents. However, withdrawal of such agents in patients with osteoporosis may increase the risk of fracture. The treatment of MRONJ is challenging, and standard treatment guidelines have yet to be established. In this study, the aim was to find out whether adjuvant daily or weekly teriparatide (TPTD) injections were beneficial for exposed bony MRONJ lesions compared with standard conservative management. We also studied the complications and the patients' response to TPTD therapy. We enrolled 27 patients (January 2012 - December 2016) with chronic and refractory MRONJ. There were four men and 23 women (85% female). Nine patients who did not select TPTD therapy for several reasons formed the non-TPTD group; the remaining 18 were randomly assigned to the daily (n=9) or weekly (n=9) groups. All patients in both groups continued standard conservative therapy in addition to their daily or weekly subcutaneous injection of TPTD (20 μg or 56.5 μg, respectively). We evaluated the complications of TPTD and its benefits. Three patients in the daily group did not complete the study, resulting in six patients in the daily group, nine in the weekly group, and nine in the non-TPTD group in the final analysis. The exposed bone was completely covered with normal mucosa in all patients in the TPTD groups, and the healing period was shorter than that in the non-TPTD group. No patient had complications of atypical fractures of the femoral head. Daily and weekly TPTD treatment resulted in a shortened treatment period compared with standard conservative therapy, with no increase in the rate of complications or worsening of osteoporosis.
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Affiliation(s)
- Daigo Yoshiga
- Department of Science of Physical Function, Division of Oral Medicine, Kyushu Dental University, Fukuoka, Japan.
| | - Izumi Yoshioka
- Department of Science of Physical Function, Division of Oral Medicine, Kyushu Dental University, Fukuoka, Japan
| | - Manabu Habu
- Department of Science of Physical Function, Division of Maxillofacial Surgery, Kyushu Dental University, Fukuoka, Japan
| | - Masaaki Sasaguri
- Department of Science of Physical Function, Division of Maxillofacial Surgery, Kyushu Dental University, Fukuoka, Japan
| | - Kazuhiro Tominaga
- Department of Science of Physical Function, Division of Maxillofacial Surgery, Kyushu Dental University, Fukuoka, Japan
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Liu J, Mattheos N, Deng C, Su C, Wang Z, Luo N, Tang H. Management of medication-related osteonecrosis of jaw: Comparison between icariin and teriparatide in a rat model. J Periodontol 2020; 92:149-158. [PMID: 32281098 DOI: 10.1002/jper.19-0620] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/05/2020] [Accepted: 03/15/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of this study is to compare the effects of icariin and teriparatide on the treatment of medication-related osteonecrosis of the jaw (MRONJ) using a rat model. METHODS Fifty rats undergoing ovariectomy were randomly assigned to control group (n = 10) and the MRONJ model group (n = 40). Zoledronic acid (0.2 mg/kg) and dexamethasone (2 mg/kg) were injected into rats in the model group for 8 weeks while saline was applied in control group, then all rats underwent tooth extraction and bone defect. Eight weeks later, rats diagnosed with MRONJ (n = 33) were randomly distributed to icariin (n = 11), teriparatide (n = 11), and the untreated (n = 11) group, and rats received daily 150 mg/kg icariin, 20 µg/kg teriparatide, and no intervention, respectively, for 8 weeks. Then, mandibulars were dissected for later examination. RESULTS Rats diagnosed with MRONJ (33/40) demonstrated significantly larger area of soft tissue wound and necrotic bone with higher ratio of empty bone lacuna. Area of soft tissue wound and ratio of empty bone lacuna were significantly decreased in the icariin group compared with the untreated group, while teriparatide group revealed significantly higher ratio of receptor activator of NF-kB ligand (RANKL)-positive osteocytes, smaller area of necrotic bone and lower ratio of empty lacuna. The two agents were related to higher expression of BMP-2 in osteocytes but were not statistically significant. CONCLUSIONS Icariin benefits MRONJ in terms of the area of soft tissue wound and ratio of empty lacuna. Teriparatide activates expression of RANKL and reduces the area of bone necrosis and ratio of empty lacuna in a MRONJ lesion. The data suggest possible healing improvement in patients with MRONJ and further studies to prove the efficacy of icariin.
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Affiliation(s)
- Jie Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Nikos Mattheos
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Chuanxi Deng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Cheng Su
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zekun Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Nanyu Luo
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hua Tang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Sølling ASK, Harsløf T, Langdahl B. Current Status of Bone-Forming Therapies for the Management of Osteoporosis. Drugs Aging 2019; 36:625-638. [DOI: 10.1007/s40266-019-00675-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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