Bisphosphonate related osteonecrosis of the jaws: Clinico-pathological investigation and histomorphometric analysis

Karen Anavi-Lev, Yakir Anavi, Gavriel Chaushu, Dror M. Alon, Gal Gavriel, Ilana Kaplan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives: Clinico-pathological evaluation of bisphosphonate (BP)-related osteonecrosis of jaws, comparison between oral (PO) and intravenous (IV) BPs and histomorphometric analysis of associated actinomyces. Study design: 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. Conclusion: 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.

Original languageEnglish
Pages (from-to)660-666
Number of pages7
JournalOral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Issue number5
StatePublished - May 2013


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