Osteopathology associated with bone resorption inhibitors – which role does Actinomyces play? A presentation of 51 cases with systematic review of the literature

Abstract

The pathogenesis of BRIOJ remains unknown; however, there seems to be a role for Actinomyces, and possibly other pathogens, in the development of osteopathology of the jaws, which is not exclusive to bisphosphonate therapy. This study supports the hypothesis that an infectious component is of utmost importance for the pathogenesis of BRIOJ.

Treatment perspectives for medication-related osteonecrosis of the jaw (MRONJ)

“…Given that necrotic and exposed bone will not revitalize, resurrected MRONJ should be removed, in particular in light of the fact that small residuals can lead to a recurrence or progression of MRONJ due to mechanical injury of the mucosa. In addition, exposed bone is susceptible to bacterial colonization and infection, in particular the gram-positive actinomyces (Schipmann et al, 2013;Sedghizadeh et al, 2008). Microbes may therefore play a role in the pathogenesis and aggravation of an existing MRONJ.…”

Actinomyces and Related Organisms in Human Infections

“…Bisphosphonates are commonly used drugs in oncology. Bisphosphonaterelated osteonecrosis of the jaws (BRONJ) is widely considered a specific disease entity where Actinomyces organisms may play an important role (54,149). In three case series on BRONJ including a total of 96 patients, the rate of detection of Actinomyces varied between 53% and 86% (54,150,151).…”

“…The disease can also appear as cutaneous actinomycosis, musculoskeletal disease, pericarditis, infection of the central nervous system (CNS), or disseminated disease. Moreover, some actinomycosis cases have been linked to specific conditions, such as osteoradionecrosis or bisphosphonate-related osteonecrosis of the jaws (53,54), the use of anti-inflammatory drugs (55,56), or some hereditary diseases (57,58). Also, unusual presentations of human actinomycosis have been reported, which presents a diagnostic challenge (59).…”

“…Bisphosphonaterelated osteonecrosis of the jaws (BRONJ) is widely considered a specific disease entity where Actinomyces organisms may play an important role (54,149). In three case series on BRONJ including a total of 96 patients, the rate of detection of Actinomyces varied between 53% and 86% (54,150,151). As known for most actinomycosis cases, concomitant or coinfecting organisms are usually present; therefore, it is conceivable that multiple bacterial morphotypes, located on active sites of bone resorption, were seen in BRONJ lesions examined by scanning electron microscopy (152).…”

Is Bisphosphonate-Related Osteonecrosis of the Jaw an Infection? A Histological and Microbiological Ten-Year Summary

“…While interesting, the clinical utility of knowing that Actinomyces colonization is abundant in BRONJ lesions has thus far been limited [17]. However, a retrospective analysis by Kaplan et al regarding antibiotic treatment and Actinomyces bacterial load (number of colonies/surface area of tissue) showed a direct correlation between histomorphometric parameters of Actinomyces colonies and clinical course [18, 19].…”