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Histomorphologic characteristics of bisphosphonate‐related osteonecrosis of the jaw
Author(s) -
Koerdt Steffen,
Dax Svenja,
Grimaldi Hannes,
Ristow Oliver,
Kuebler Alexander C.,
Reuther Tobias
Publication year - 2014
Publication title -
journal of oral pathology and medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.887
H-Index - 83
eISSN - 1600-0714
pISSN - 0904-2512
DOI - 10.1111/jop.12156
Subject(s) - osteonecrosis of the jaw , medicine , bisphosphonate , context (archaeology) , bone remodeling , jaw bone , pathogenesis , osteoclast , bisphosphonate associated osteonecrosis of the jaw , dentistry , pathology , osteoporosis , surgery , biology , implant , paleontology , receptor
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 A ctinomyces 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 A ctinomyces 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.