title: The association of medication-related osteonecrosis of the jaw with Actinomyces spp. infection.
abstract: Medication-related osteonecrosis of the jaw (MRONJ) represents a complication of bisphosphonate treatment that responds poorly to standard treatment. In a retrospective cohort study we investigated a possible role of Actinomyces spp. in the pathogenesis of MRONJ. Deep biopsies of necrotic bone were collected during surgical treatment of MRONJ and evaluated by histology and microbiology for the presence of Actinomyces spp. Microbiological, demographic and clinicpathological data were analyzed for risk of Actinomyces-associated MRONJ. Between 2005 and 2014, 111 patients suffering from histologically-confirmed MRONJ were identified. Actinomyces spp. were detected in 99 cases (89%) by histology and in six further patients by microbiological culture. A diverse microbial flora was found in all specimens without association with Actinomyces spp. Demographic and clinicopathological characteristics did not separate significantly Actinomyces-positive from Actinomyces-negative cases. Our observations confirm previous reports of a high prevalence of Actinomyces spp. in MRONJ in the single largest cohort available up to now. The high prevalence of Actinomyces spp. and the lack of clinicopathological risk factors underline the prominent role of Actinomyces spp. in MRONJ and may change the current understanding of MRONJ. Established prolonged antimicrobial treatment regimens against Actinomyces spp. infection could therefore be a mainstay of future MRONJ management.
authors.affiliation: Department of Oral- and Maxillofacial Surgery, Medical University of Vienna, Austria.
authors.forename: Guenter
authors.initials: G
authors.lastname: Russmueller
authors.affiliation: Department of Oral- and Maxillofacial Surgery, Medical University of Vienna, Austria.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Seemann
authors.affiliation: Department of Medicine I, Medical University of Vienna, Austria.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Weiss
authors.affiliation: Department of Oral- and Maxillofacial Surgery, Medical University of Vienna, Austria.
authors.forename: Victoria
authors.initials: V
authors.lastname: Stadler
authors.affiliation: Department of Oral- and Maxillofacial Surgery, Medical University of Vienna, Austria.
authors.forename: Manuel
authors.initials: M
authors.lastname: Speiss
authors.affiliation: Department of Oral- and Maxillofacial Surgery, Medical University of Vienna, Austria.
authors.forename: Christos
authors.initials: C
authors.lastname: Perisanidis
authors.affiliation: Department of Medicine I, Medical University of Vienna, Austria.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Fuereder
authors.affiliation: Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Austria.
authors.forename: Birgit
authors.initials: B
authors.lastname: Willinger
authors.affiliation: Department of Pathology, Medical University of Vienna, Austria.
authors.forename: Irene
authors.initials: I
authors.lastname: Sulzbacher
authors.affiliation: Department of Medicine I, Medical University of Vienna, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Steininger
mesh_terms: D000190:Actinomyces / Q000302:isolation & purification / Q000472:pathogenicity*; D000368:Aged; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced* / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D004164:Diphosphonates