In November 2011, after a consultation with an osteoporosis expert at the Orthopedic Medicine Clinic of our hospital, alendronate therapy was stopped and subcutaneous teriparatide therapy at a dose of 20 μg per day was started. During the course of the teriparatide therapy, the patient continued to use 0.02% benzalkonium chloride solution for local irrigation.

In April 2012, after 5 months of teriparatide therapy, the sequestrum separation had progressed (Fig. 3), and a sequestrectomy was performed under general anesthesia (Fig. 4). At 5 months after the operation, a CT scan revealed new bone formation around the bone defect in the region of the sequestrectomy, with all symptoms including bone exposure disappearing (Fig. 5). The patient’s osteoporosis treatment was continued, and 16 months after the sequestrectomy, further new bone formation was observed (Fig. 6).