From the Research
Teriparatide is generally more effective than alendronate for treating osteonecrosis, particularly in cases of medication-related osteonecrosis of the jaw (MRONJ) and avascular necrosis. Teriparatide, typically administered as a daily 20mcg subcutaneous injection for 6-24 months, stimulates new bone formation by activating osteoblasts, which helps regenerate damaged bone tissue and improve vascularity in necrotic areas. In contrast, alendronate (typically 70mg orally once weekly) works by inhibiting osteoclast activity to prevent bone resorption, which may be less beneficial in osteonecrosis where bone formation is already compromised. Some key points to consider when choosing between teriparatide and alendronate include:
- The potential for teriparatide to stimulate bone formation and improve bone quality, as seen in a study published in the International Journal of Oral and Maxillofacial Surgery 1
- The finding that teriparatide may reduce the rate of advanced collapse in nontraumatic osteonecrosis of the femoral head, as reported in a study published in BMC Musculoskeletal Disorders 2
- The results of a meta-analysis showing that teriparatide may be superior to alendronate for increasing lumbar spine bone mineral density in postmenopausal osteoporosis patients 3 However, teriparatide is contraindicated in patients with bone metastases, prior radiation therapy to the skeleton, or hypercalcemia, and its use is limited to 24 months due to potential osteosarcoma risk. Cost is another consideration, as teriparatide is significantly more expensive than alendronate. For patients with severe osteonecrosis or those who have failed bisphosphonate therapy, teriparatide may be the preferred option despite these limitations. It's also worth noting that the effects of daily or cyclic teriparatide on bone formation in the iliac crest have been studied, with results suggesting that addition of either cyclic or daily teriparatide to ongoing alendronate treatment may be an effective approach for patients with severe osteoporosis already treated with alendronate who remain at high risk of fracture 4.