How do you approach long term management of glucocorticoid-induced osteoporosis in patients who develop osteonecrosis of the jaw on antiresorptive agent?

Osteonecrosis of the jaw is a rare complication of anti-resorptives with the exception of high doses used for cancer patients. Teriparatide (TPTD) has been anecdotally reported to assist in healing of ONJ. The patient described remains on glucocorticoids and is at very high risk for fracture, especi...

Use a different agent. If onj happened on a bisphosphonate go to danosumab. Risk factors should also be optimized. If dental surgery is scheduled hold the anti-resorptive.