Az osteoporosis a civilizált világban az ötven évesnél idősebb korosztályban az egyik leggyakoribb, az életminőséget súlyosan rontó állapot. A csonttömegvesztés megelőzésében és kezelésében ma a legelterjedtebb az antireszorptív gyógyszerek alkalmazása, amelyek az osteoclastok blokkolása révén lassítják a csonttömeg vesztését. Az antireszorptív kezelés egyik, bár nem gyakori vezető mellékhatása az invazív szájsebészeti beavatkozások után előforduló csontnekrózis, amely „medication-related osteonecrosis of the jaw (MRONJ)” néven szerepel az angolszász irodalomban. Az osteoporosis kezelésében az utóbbi két évtizedben fokozatosan egyre nagyobb teret követelnek maguknak az anabolikus hormonkészítmények, elsősorban a rekombináns humán parathormon (1–34) alkalmazása. E hormonkészítmény teriparatid néven már több mint két évtizede van klinikai alkalmazásban. Egyes közlemények szerint a teriparatid hatásosabb a csontsűrűség megtartásában és a patológiás csonttörések kezelésében, mint az antireszorptív gyógyszerek. Igazolt, hogy a napi egyszeri dózisban adott parathormon fokozza az összehangolt csontátépülést, és a folyamatot a csontképzés irányába tolja el. Számos állatkísérlet és humán klinikai vizsgálatok igazolták, hogy a szisztémásan, napi egyszeri dózisban adott teriparatid gyorsította a callusképződést, lerövidítette a gyógyulási időt, és egyben javultak a csont mechanikai tulajdonságai is. A parathormon ún. „off-label” indikációja azonban még mindig nem megalapozott. Ugyanakkor egyre több olyan adat gyűlt össze a nemzetközi irodalomban, miszerint a teriparatid hatásos az egyébként hagyományos kezelésre rezisztens, gyógyszer okozta állcsontnekrózis gyógyításában is. A közlemény célja összefoglalni a parathormon anabolikus farmakológiai hatásával kapcsolatos irodalmat és az elmúlt évtizedben az irodalomban közölt eredmények alapján a parathormon alkalmazásával az antireszorptív gyógyszerek okozta állcsontnekrózisok terápiájában elért eredményeket. Az elmúlt 15 évben megjelent nagyszámú esetközlemény és a limitált számú klinikai vizsgálat eredményei alapján feltételezhető, hogy a teriparatidkészítményeket alkalmazni lehetne a hagyományos kezelésre rezisztens állcsontnekrózisok kezelésében is. Ám még további randomizált, kontrollált klinikai vizsgálatokra van szükség ahhoz, hogy kimondható legyen: a teriparatid valóban hatékony és biztonságos kezelési alternatíva lenne a hagyományos kezelésre nem reagáló, gyógyszer okozta állcsontnekrózis-esetek kezelésében. Orv Hetil. 2023; 164(36): 1406–1415.
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