title: [Bisphosphonate related osteonecrosis of the jaw and infection with Actinomyces].
abstract: OBJECTIVE
  Bisphosphonate related osteonecrosis of the jaw (BRONJ) has raised considerable interest since its recent description. Its pathogenesis is not yet clarified; formerly it has been considered a non-infectious complication, but recent studies seem to implicate bacteria of the genus Actinomyces. The objective of this study is to analyze the cases of BRONJ in our institution.
  
  
  METHODS
  Review of medical records of patients diagnosed of BRONJ in the Maxillofacial Surgery Unit of our hospital.
  
  
  RESULTS
  We have found 11 cases of BRONJ in our hospital: 4 women taking oral alendronate or risendronate for osteoporosis and 7 cancer patients treated with intravenous zolendronic acid. All of them showed bone invasion by bacteria of the genus Actinomyces. Nine patients underwent prolonged treatment with amoxicillin with favourable clinical outcome in all of them, but 3 died of their malignancy. By contrast, one patient with beta-lactamic allergy and irregular treatment with erythromycin and tetracycline had a chronic evolution of the lesions. There was no information for other patient.
  
  
  CONCLUSIONS
  Actinomyces play an important role in the development of BRONJ and specific antibiotic treatment improves the prognosis of this process.
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España. jarranz.hupa@salud.madrid.org
authors.forename: J Alberto
authors.initials: JA
authors.lastname: Arranz Caso
authors.forename: Elena
authors.initials: E
authors.lastname: Flores Ballester
authors.forename: Stephanie
authors.initials: S
authors.lastname: Ngo Pombe
authors.forename: Victor
authors.initials: V
authors.lastname: López Pizarro
authors.forename: José Luis
authors.initials: JL
authors.lastname: Dominguez-Mompello
authors.forename: Andrés
authors.initials: A
authors.lastname: Restoy Lozano
mesh_terms: D000190:Actinomyces / Q000302:isolation & purification / Q000472:pathogenicity*; D000196:Actinomycosis / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000453:epidemiology* / Q000382:microbiology / Q000601:surgery; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D001851:Bone Diseases, Metabolic / Q000150:complications / Q000188:drug therapy; D003131:Combined Modality Therapy; D004164:Diphosphonates / Q000009:adverse effects; D004198:Disease Susceptibility; D012968:Etidronic Acid / Q000009:adverse effects / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects; D008297:Male; D008336:Mandibular Diseases / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D008439:Maxillary Diseases / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D008875:Middle Aged; D008954:Models, Biological; D009369:Neoplasms / Q000150:complications; D010000:Osteitis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy; D012189:Retrospective Studies; D000068296:Risedronic Acid; D000077211:Zoledronic Acid
chemical_list: D000900:Anti-Bacterial Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D000068296:Risedronic Acid; D012968:Etidronic Acid; D019386:Alendronate