{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:24:38Z","timestamp":1791559478289,"version":"4.3.4"},"reference-count":19,"publisher":"The Endocrine Society","issue":"10","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Medication-related osteonecrosis of the external auditory canal (MROEAC) is a rare complication of antiresorptive therapy, and guidance for diagnosis and management remains limited. We describe 2 patients with prolonged antiresorptive exposure who developed MROEAC and were treated with teriparatide. An 81-year-old woman developed bilateral external auditory canal erosions after 10 years of denosumab therapy. An 8-week course of teriparatide was associated with clinical improvement and a transient rise in bone formation markers, but computed tomography findings remained unchanged. Denosumab withdrawal led to delayed rebound bone resorption, prompting denosumab reintroduction. A 67-year-old woman developed left-sided MROEAC after 15 years of alendronate followed by a short course of denosumab. Four months of teriparatide was associated with symptomatic and biochemical improvement, but radiologic abnormalities persisted, and definitive surgery was required. These cases highlight the difficulty of differentiating MROEAC from more common otologic disorders, the discordance between clinical, biochemical, and radiologic response, the importance of multidisciplinary management, and therapeutic challenges created by denosumab discontinuation. Teriparatide was well tolerated and was associated with increased bone turnover markers, but radiologic resolution was incomplete. Surgical management may still be necessary.<\/jats:p>","DOI":"10.1210\/jcemcr\/luag238","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T11:12:25Z","timestamp":1786101145000},"source":"Crossref","is-referenced-by-count":1,"title":["Medication-related osteonecrosis of the external auditory canal and treatment with teriparatide"],"prefix":"10.1210","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5296-0526","authenticated-orcid":false,"given":"Daheng","family":"Xia","sequence":"first","affiliation":[{"name":"Department of Geriatric Medicine, Royal Perth Bentley Group , Perth, WA 6000 ,","place":["Australia"]},{"name":"WA Country Health Service , Perth, Western Australia 6000 ,","place":["Australia"]},{"name":"Department of Acute and General Medicine, Fiona Stanley Fremantle Hospitals Group , Perth, WA 6150 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2505-9423","authenticated-orcid":false,"given":"Matthew J M","family":"Ting","sequence":"additional","affiliation":[{"name":"Department of Geriatric Medicine, Royal Perth Bentley Group , Perth, WA 6000 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9830-259X","authenticated-orcid":false,"given":"Marcus D","family":"Atlas","sequence":"additional","affiliation":[{"name":"Ear Sciences Centre, Medical School, University of Western Australia , Nedlands, WA 6009 ,","place":["Australia"]},{"name":"Ear Science Institute Australia , Subiaco, WA 6008 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudolf","family":"Boeddinghaus","sequence":"additional","affiliation":[{"name":"Perth Radiological Clinic , Subiaco, WA 6008 ,","place":["Australia"]},{"name":"Medical School, University of Western Australia , Nedlands, WA 6009 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9109-9864","authenticated-orcid":false,"given":"Bronwyn G A","family":"Stuckey","sequence":"additional","affiliation":[{"name":"Medical School, University of Western Australia , Nedlands, WA 6009 ,","place":["Australia"]},{"name":"Keogh Institute for Medical Research, Nedlands , WA 6009 ,","place":["Australia"]},{"name":"Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital , Nedlands, WA 6009 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"issue":"2","key":"2026091603525389900_luag238-B1","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1111\/scd.12893","article-title":"Medication-related osteonecrosis of the external auditory canal - A rapid review of the literature and relevance to special care dentists","volume":"44","author":"Khan","year":"2024","journal-title":"Spec Care Dentist"},{"issue":"2","key":"2026091603525389900_luag238-B2","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1097\/MAO.0b013e31827ca34d","article-title":"Osteonecrosis of the external auditory canal associated with oral bisphosphonate therapy: case report and literature review","volume":"34","author":"Salzman","year":"2013","journal-title":"Otol Neurotol"},{"issue":"10","key":"2026091603525389900_luag238-B3","doi-asserted-by":"crossref","DOI":"10.1093\/jbmrpl\/ziaf134","article-title":"Osteonecrosis of the external auditory canal in two patients on denosumab therapy","volume":"9","author":"Wang","year":"2025","journal-title":"JBMR Plus"},{"issue":"3","key":"2026091603525389900_luag238-B4","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1007\/s13691-025-00772-z","article-title":"Bilateral osteonecrosis of the external auditory canal caused by bone-modifying agents for cancer bone metastases","volume":"14","author":"Yamaguchi","year":"2025","journal-title":"Int Cancer Conf J"},{"issue":"5","key":"2026091603525389900_luag238-B5","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1177\/01455613211053389","article-title":"Denosumab-related osteonecrosis of the external auditory canal-benefit of the early surgical management","volume":"103","author":"Perina","year":"2024","journal-title":"Ear Nose Throat J"},{"issue":"26","key":"2026091603525389900_luag238-B6","doi-asserted-by":"crossref","first-page":"2971","DOI":"10.1200\/JCO.19.02192","article-title":"Teriparatide promotes bone healing in medication-related osteonecrosis of the jaw: a placebo-controlled, randomized trial","volume":"38","author":"Sim","year":"2020","journal-title":"J Clin Oncol"},{"issue":"12","key":"2026091603525389900_luag238-B7","doi-asserted-by":"crossref","first-page":"2449","DOI":"10.1007\/s00198-021-06078-z","article-title":"Is teriparatide therapy effective for medication-related osteonecrosis of the jaw? 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