REVIEW article
Front. Med.
Sec. Translational Medicine
Targeted drug repurposing in medication-related osteonecrosis of the jaw: A review of teriparatide and pentoxifylline/α-tocopherol protocols
Weijia Huang 1
Jishizhan Chen 2
Quan Zhou 1
Azadeh Rezaei 2
1. Zhejiang University, Hangzhou, China
2. University College London, London, United Kingdom
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Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse effect associated with antiresorptive and antiangiogenic treatments commonly prescribed for patients with cancer or osteoporosis. The increasing prescription of these drugs, coupled with the introduction of new anticancer medications, has raised concerns regarding the increasing risk of MRONJ. While the precise mechanisms underlying MRONJ remain unclear and effective therapies are still lacking, two repurposed pharmacological protocols—teriparatide (TPTD) and the combination of pentoxifylline (PTX) and α-tocopherol (TOC) [PENTO protocol]—have demonstrated potential therapeutic benefits. However, large-scale clinical evidence remains insufficient. This review evaluates the therapeutic potential of these targeted drug repurposing protocols, exploring their mechanisms of action in MRONJ management and proposing a clinical application protocol for both prevention and treatment. This study also highlights the potential of drug repurposing as a rapid and cost-effective approach for MRONJ management, particularly for patients with cancer, and emphasises the need for further research on personalised and localised management strategies. Nevertheless, the current evidence base is limited by small sample sizes, heterogeneous patient populations, non-randomised study designs, and inconsistent outcome measures, precluding definitive conclusions regarding efficacy and optimal clinical use.
Summary
Keywords
Anti-cancer drug, drug repurposing, Medication-related osteonecrosis of the jaw (MRONJ), pentoxifylline (PTX), Teriparatide, α-tocopherol (TOC)
Received
20 November 2025
Accepted
13 February 2026
Copyright
© 2026 Huang, Chen, Zhou and Rezaei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Weijia Huang; Azadeh Rezaei
Disclaimer
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