The most frequent presentation of BRONJ is a small amount of bare bone that is not painful or inflamed, which may heal quickly, slowly, LY3009104 mouse or not at all. Most cases are not as severe as in the patients presented above. Recently, it has been suggested that N-BP treatment may cause BRONJ [4]. BRONJ is much more frequent in patients receiving intravenous N-BP for the treatment and prevention of cancer-related skeletal conditions than in patients receiving oral N-BP for the treatment of non-malignant disease [5]. BRONJ may be associated with the type and total dose of N-BP treatment, and with a history of trauma, dental surgery, and dental infection [6]. We described an 87-year-old

female with stage 3 BRONJ that persisted after control of the bone

and soft tissue infections, who required tooth extractions 3 months after the withdrawal of N-BP treatment. The main effects of N-BP are at the lumbar KU-60019 purchase spine and proximal femur, where they stop bone loss, reduce fracture risk, and increase bone mineral density. Local trauma and infection in the jaw increase the demand for bone repair, which may exceed the low turnover rate of the bone, resulting in the accumulation of necrotic bone that is recognized as osteonecrosis of the jaw. There are some previous reports of TPTD treatment in patients with osteonecrosis of the jaws associated 3-mercaptopyruvate sulfurtransferase with N-BP therapy [7–9]. Additionally, several patients treated with daily TPTD injections have now been reported, but the

number of reports is limited and the evidence to date is mostly anecdotal [10–12]. TPTD injection is a unique pharmacological treatment for patients with primary osteoporosis. TPTD treatment stimulates bone see more formation and increase bone mineral density [13]. TPTD may counteract the mechanisms causing BRONJ by stimulating bone formation. An increase in the number of remodeling units and increased bone formation within each unit may promote healing and the removal of damaged bone. In case 2, the mandibular fracture and bone necrosis were successfully treated with daily TPTD injections, without the need for surgery, which is similar to the patient reported by Cheung and Seeman [8], who received the administration of TPTD for osteonecrosis of the jaw in association with alendronate therapy. In both our patients, TPTD treatment was effective and achieved soft tissue coverage of exposed bone. This is the first report describing successful treatment of BRONJ with weekly TPTD injections. In conclusion, the outcomes of the cases presented suggest that weekly TPTD injections can be effective for the treatment of stage 3 BRONJ. If weekly and daily TPTD injections are both effective, we can choose the TPTD treatment regimen according to the condition of the patient.