Teriparatide may benefit patients with localized jaw bone defects

Bashutski JD. New Engl J Med. doi:10.1056/NEJMoa1005361.

A 6-week course of teriparatide, in conjunction with periodontal surgery, was associated with a greater resolution of osseous defects in patients with periodontal disease than placebo, according to the results of a Level 1 trial.

The single-center, randomized, placebo-controlled, double-blind, parallel-design trial included 40 patients with severe periodontal disease who underwent periodontal surgery. For 6 weeks, the patients also received daily 20µg injections of teriparatide or placebo along with 1000 mg of oral calcium and 800 IUs of vitamin D. Jill D. Bashutski, DDS, of the Michigan Center for Oral Health Research, and colleagues followed the patients for 1 year after surgery.

The researchers evaluated periodontal probing depth, clinical attachment level and bleeding on probing at baseline, 6 weeks and at 3, 6, 9 and 12 months. They obtained full-mouth radiographs at baseline and 12 months. They also obtained periapical and bitewing radiographs of the surgical site at baseline and at 3, 6, 9 and 12 months.

A 6 months postoperatively, teriparatide treatment had a significantly greater radiographic linear resolution of osseous defects vs. placebo. Teriparatide had a 29% mean linear gain in bone at 1 year compared with 3% for placebo. Patients on teriparatide had greater clinical improvement, with a 33% reduction in periodontal probing depth compared with 20% for patients in the placebo group. At 1 year postoperatively, patients in the teriparatide group had a 22% gain in clinical attachment level vs. 7% for placebo in target lesions.

“Our study has several limitations,” the authors wrote. “Because the study sample was small, the results should be interpreted with caution. In addition, adverse events that do not occur at high frequency could not be detected.”