Department of Cranio-maxillofacial and Oral Surgery, University of Zurich, Zurich, Switzerland.
J Oral Pathol Med. 2013 Sep;42(8):587-93. doi: 10.1111/jop.12038. Epub 2013 Feb 1.
Bone resorption inhibitor-related osteopathology of the jaw (BRIOJ) is a severe complication in patients treated with bisphosphonates or denosumab. However, the precise pathogenesis of BRIOJ is not yet fully understood. Recent studies discovered the presence of Actinomyces colonies in biopsy material from BRIOJ patients. The aim of this study was to analyze current knowledge concerning the impact of Actinomyces on the pathogenesis of this condition and to present data from our own patients.
Data from 51 patients with histopathological diagnoses of BRIOJ were retrospectively analyzed. In addition, a systematic literature search for studies describing the presence of Actinomyces was performed.
Actinomyces was present in 86% of our cases and 63.3% of 371 cases presented in the literature. All of our patients and 85% of patients described in the literature had a clearly defined local focus in association with osteopathology. A clear picture of whether Actinomyces colonizes the previously necrotic bone or contributes to inflammation causing subsequent bone necrosis is lacking in the literature.
The pathogenesis of BRIOJ remains unknown; however, there seems to be a role for Actinomyces, and possibly other pathogens, in the development of osteopathology of the jaws, which is not exclusive to bisphosphonate therapy. This study supports the hypothesis that an infectious component is of utmost importance for the pathogenesis of BRIOJ.
颌骨骨吸收抑制剂相关性骨病（BRIOJ）是接受双膦酸盐或地舒单抗治疗的患者的一种严重并发症。然而，BRIOJ 的确切发病机制尚未完全阐明。最近的研究发现 BRIOJ 患者的活检材料中存在放线菌菌落。本研究旨在分析当前关于放线菌对该疾病发病机制影响的知识，并呈现我们自己患者的数据。
回顾性分析了 51 例经组织病理学诊断为 BRIOJ 的患者的数据。此外，还对描述放线菌存在的文献进行了系统的文献检索。
我们的病例中有 86%存在放线菌，文献中 371 例中有 63.3%存在放线菌。我们所有的患者和文献中 85%的患者都与骨病相关，有明确的局部病灶。文献中对于放线菌是定植于先前坏死的骨还是导致随后骨坏死的炎症有关，尚不清楚。
BRIOJ 的发病机制尚不清楚；然而，放线菌（可能还有其他病原体）似乎在颌骨骨病的发生发展中起作用，而且不仅限于双膦酸盐治疗。本研究支持这样一种假设，即感染因素对 BRIOJ 的发病机制至关重要。
