title: Bisphosphonate related osteonecrosis of the jaws: clinico-pathological investigation and histomorphometric analysis.
abstract: OBJECTIVE
  Clinico-pathological evaluation of bisphosphonate (BP)-related osteonecrosis of jaws, comparison between oral (PO) and intravenous (IV) BPs and histomorphometric analysis of associated actinomyces.
  
  
  METHODS
  Retrospective clinical and histomorphometric analysis. Data on background, clinical, treatment and follow-up were analyzed. Actinomyces colonies were identified by typical filamentous colony morphology, Gram, and PAS stains. Colony density and relative colony surface area were measured.
  
  
  RESULTS
  Fifty-two patients were included, 37 (71.2%) IV, 15 (28.8%) PO BPs. with a mean duration of 2.33 and, 4.33 years respectively. One hundred percent of cases exhibited actinomyces colonization. The relative colony surface area was significantly higher in PO treatment (P = .024), with no differences in density, healing time or antibiotic treatment periods. High frequency of diabetes mellitus (60% PO cases) and corticosteroid treatment (25% of cases) were recorded.
  
  
  CONCLUSIONS
  Infection with actinomyces is a common denominator in BP-related osteonecrosis of the jaws (BRONJ), regardless of administration route. Diabetes and corticosteroid treatment seem to be important contributing factors for BRONJ.
authors.affiliation: Department of Periodontics, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel.
authors.forename: Karen
authors.initials: K
authors.lastname: Anavi-Lev
authors.forename: Yakir
authors.initials: Y
authors.lastname: Anavi
authors.forename: Gavriel
authors.initials: G
authors.lastname: Chaushu
authors.forename: Dror M
authors.initials: DM
authors.lastname: Alon
authors.forename: Gavriel
authors.initials: G
authors.lastname: Gal
authors.forename: Ilana
authors.initials: I
authors.lastname: Kaplan
mesh_terms: D000190:Actinomyces / Q000302:isolation & purification; D000196:Actinomycosis / Q000453:epidemiology*; D061605:Administration, Intravenous; D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage; D058491:Bacterial Load; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000453:epidemiology* / Q000382:microbiology; D001943:Breast Neoplasms / Q000188:drug therapy; D048909:Diabetes Complications / Q000453:epidemiology; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy; D010019:Osteomyelitis / Q000453:epidemiology / Q000382:microbiology; D010024:Osteoporosis / Q000188:drug therapy; D011471:Prostatic Neoplasms / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014945:Wound Healing / Q000502:physiology
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D004164:Diphosphonates