Histomorphologic characteristics of bisphosphonate-related osteonecrosis of the jaw

Background Bisphosphonate‐related osteonecrosis of the jaw (BRONJ) is a known side effect of the therapy with bisphosphonates. No specific pathologic aspects or histological features are included in the most current definition. This study investigates characteristics of BRONJ with a special emphasis...

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Bibliographic Details
Published in:	Journal of oral pathology & medicine Vol. 43; no. 6; pp. 448 - 453
Main Authors:	Koerdt, Steffen, Dax, Svenja, Grimaldi, Hannes, Ristow, Oliver, Kuebler, Alexander C., Reuther, Tobias
Format:	Journal Article
Language:	English
Published:	Frederiksberg Blackwell Publishing Ltd 01-07-2014 Wiley
Subjects:	Actinomyces Actinomycosis - microbiology Aged Aged, 80 and over Bacterial Load Biological and medical sciences bisphosphonate Bisphosphonate-Associated Osteonecrosis of the Jaw - microbiology Bisphosphonate-Associated Osteonecrosis of the Jaw - pathology Bone Density Conservation Agents - adverse effects Bone Remodeling - physiology Bones, joints and connective tissue. Antiinflammatory agents Case-Control Studies Cell Proliferation Dental Care Dentistry Diseases of the osteoarticular system Epithelial Cells - pathology Female Humans infected osteonecrosis Male Medical sciences Middle Aged osteoblast Osteoblasts - pathology osteoclast Osteoclasts - pathology Osteomyelitis - microbiology Osteomyelitis - pathology osteonecrosis Osteonecrosis - pathology Otorhinolaryngology. Stomatology Pharmacology. Drug treatments Risk Factors Suppuration Vascular bone diseases Jaw Antiosteoporotic Actinomycetaceae Stomatology Diseases of the osteoarticular system Actinomyces infected osteonecrosis ENT Osteoclast Osteonecrosis Bisphosphonates Actinomycetales Infection Antiosteoclastic agent Osteoblast bisphosphonate Bacteria Actinomycetes osteonecrosis osteoblast osteoclast
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Summary:	Background Bisphosphonate‐related osteonecrosis of the jaw (BRONJ) is a known side effect of the therapy with bisphosphonates. No specific pathologic aspects or histological features are included in the most current definition. This study investigates characteristics of BRONJ with a special emphasis on histomorphologic aspects, evaluating the role of Actinomyces spp. as well as other disease‐promoting factors in a formal pathogenetic context. Methods We investigated 23 patients (14 female, nine male; mean age: 66 ± 11.8 years) who received bisphosphonates with a gender‐ /age‐matched control group. Tissue specimens were treated according to local standards and analyzed histologically. Results In 18 (78.3%) BRONJ cases, we found Actinomyces spp. colonies. Bone remodeling could be found in three specimens (13%). Eight specimens (34.8%) showed signs of epithelial proliferation. Analysis of dental treatment before the onset of BRONJ did not reveal significant differences (P > 0.20). In 10 patients (83%; P > 0.05) of the reported cases a relationship between dental treatment and the occurrence of a purulent bone necrosis could be observed. Statistically significant differences in thickness of trabeculae were detected between the two study groups (P = 0.04). Conclusions This study demonstrates the important influence of the osteoblast–osteoclast balance in a histomorphologic analysis. Together with cofactors, which are able to trigger the onset of BRONJ, a new pathogenesis model was developed.
Bibliography:	ark:/67375/WNG-C383L3F3-8 ArticleID:JOP12156 istex:80130B944FAC6189CB8488680A4D37837991D8DF ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	0904-2512 1600-0714
DOI:	10.1111/jop.12156