Teriparatide Shows Strong Osteoanabolic Effects in Preclinical Guided Bone Regeneration Models: Review

Brazil: Researchers have found, in a new systematic review, that there is strong preclinical evidence that teriparatide (TP) enhances bone regeneration by promoting bone formation, osteoblast differentiation, angiogenesis, and graft integration, especially when combined with various biomaterials. Intermediate systemic and local doses were most effective, with greater benefits in mandibular, calvarial, and extraction socket models compared to sinus augmentation. A systematic review, published in Current Issues in Molecular Biology by Jessika Dethlefs Canto and colleagues from the Department of Oral Surgery at Fluminense Federal University, evaluated the effectiveness of teriparatide in guided bone regeneration (GBR). Researchers analyzed 24 preclinical studies involving diverse craniofacial models such as mandibular, calvarial, sinus augmentation, extraction sockets, distraction osteogenesis, and segmental defects. The following were the key findings of the study: Teriparatide consistently promoted osteogenesis, graft integration, angiogenesis, and mineralization across various preclinical models. The effects of teriparatide were amplified when combined with biomaterials such as polyethylene glycol (PEG), hydroxyapatite/tricalcium phosphate (HA/TCP), biphasic calcium phosphate (BCP), octacalcium phosphate collagen (OCP/Col), enamel matrix derivatives, autografts, allografts, xenografts (Bio-Oss), strontium ranelate, and bioactive glass. Intermediate systemic doses of approximately 2 µg/kg/day and local doses between 20–40 µg produced the most favorable outcomes, whereas higher doses did not consistently offer additional benefits. Anatomical differences influenced treatment effectiveness, with stronger responses observed in mandibular and calvarial models compared to sinus augmentation cases. The authors note that despite these promising findings, the review highlighted critical methodological limitations. Most studies exhibited a moderate-to-high risk of bias, particularly in areas like randomization, allocation concealment, and blinding. The lack of adherence to established preclinical reporting standards, such as ARRIVE or PREPARE guidelines, further limited reproducibility and comparability. Variations in animal models, administration regimens, defect sizes, and follow-up periods also hindered the development of standardized protocols. “While preclinical data strongly support teriparatide’s osteoanabolic effects, translating these results into clinical practice requires rigorously designed human trials,” the authors emphasized. They emphasized the importance of dose-escalation studies, investigations into combination therapies, and evaluations in clinically relevant scenarios, such as trauma-induced bone loss, reconstruction after tumor resection, osteoporotic conditions, and peri-implant bone regeneration. The review concludes that teriparatide holds significant promise as an adjunctive therapy for guided bone regeneration in oral and maxillofacial surgery. However, its clinical application remains dependent on future high-quality randomized controlled trials to establish optimal dosing strategies, delivery methods, and long-term safety profiles. "Robust, well-structured randomized clinical trials are essential to determine the ideal dosing strategies, effective delivery methods, and long-term safety of teriparatide for use in oral and maxillofacial bone regeneration," the authors wrote. Reference: Canto, J. D., Mourão, C. F., Moraschini, V., Sartoretto, S. C., Diuana, M., Granjeiro, J. M., & Louro, R. S. (2025). Teriparatide for Guided Bone Regeneration in Craniomaxillofacial Defects: A Systematic Review of Preclinical Studies. Current Issues in Molecular Biology, 47(8), 582. https://doi.org/10.3390/cimb47080582