Aydın KESKİNRÜZGAR, Saim YANIK, Mutan ARAS, Sedat ÇETİNER

Teriparatid [paratiroid hormon (1-34)] ve diş hekimliği

Teriparatid kemik kalitesini ve kemik yoğunluğunu arttırmak amacıyla paratiroid hormunundan elde edilen yeni bir ajandır. Paratiroid hormon, kalsiyum ve fosfat metabolizmasını düzenleyererek kemik yapımından sorumlu tutulmaktadır. Teriparatidin osteoporoz hastalarında antirezorptif ajanlara alternatif bir tedavi olması güncel bir konudur. Kemik mineral dansitesinin düşük veya kemik kitlesinin kalitesiz olduğu durumlarda kemik yıkımını engelleyen bu ajanın diğer antirezorptif ajanlardan farklı olarak kemik üzerindeki anabolik etkisi belirtilmiştir. Teriparatidin mekanizmasında, osteoklastlar uyarılarak kemik yıkımının başlatıldığı, diğer bir taraftan ise osteoblastların uyarıldığı belirtilmiştir. Teriparatidin bu özelliği bazı araştırmacıları bu ajanı osteoporoz dışındaki bifosfonat ile ilişkili osteonekroz vakalarında ve periodontal kemik defektlerinde kullanmaya yöneltmiştir. Yapılan araştırmalarda teriparatidin klinik olarak ciddi bir yan etkisinin rapor edilmemesine rağmen kemik üzerindeki anabolik etkisinden dolayı osteosarkom riski vurgulanmıştır. Buna karşın, yapılan klinik araştırmalarda böyle bir durum bildirilmemiştir. Literatürde, yeni bir ajan olan teriparatid ile ilgili az sayıda vaka mevcuttur. Bu ilacın uzun dönem etkilerini belirleyebilmek için bu konuda daha çok prospektif randomize çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Çenenin bifosfonat ilişkili osteonekrozu, osteoporoz, paratiroid hormonu, teriparatid

Teriparatide [parathyroid hormone (1-34)] and dentistry

Teriparatide is a new synthetic parathyroid hormone recently used with a purpose to improve the thickness and the quality of bone. Parathyroid hormone regulates the metabolism of calcium and phosphate and is responsible for bone formation. Teriparatide is a new antiosteoporosis drug and is known to prevent bone resorption in cases where mineral density is low or the quality of bone is inferior. Unlike other antiresorptive agents it possesses an anabolic effect on bone. In its mechanism of action, when bone resorption starts with osteoclast stimulation, osteoblasts are stimulated at the same time, resulting in the aforementioned anabolic effect. This effect has tempted researches to use this agent in cases of biphosphonate related osteonecrosis and periodontal bone defects. Research reveals no serious clinical side effects associated with this agent; however, a risk of osteosarcoma due to its anabolic effect on bone should be considered. Yet, no case of osteosarcoma related to the teriparatide use has been reported so far. In the literature, there exists only few case reports that has used teriparatide. Prospective randomized studies are needed to evaluate the long-term effectiveness of this drug.

Keywords:

Bisphosphonate-associated osteonecrosis of the jaw, osteoporosis, parathyroid hormone, teriparatide,

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