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Jelin-Uhlig S, Weigel M, Ott B, Imirzalioglu C, Howaldt HP, Böttger S, Hain T. Bisphosphonate-Related Osteonecrosis of the Jaw and Oral Microbiome: Clinical Risk Factors, Pathophysiology and Treatment Options. Int J Mol Sci 2024; 25:8053. [PMID: 39125621 PMCID: PMC11311822 DOI: 10.3390/ijms25158053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/11/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024] Open
Abstract
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) represents a serious health condition, impacting the lives of many patients worldwide. The condition challenges clinical care due to its complex etiology and limited therapeutic options. A thorough understanding of the pathophysiological and patient-related factors that promote disease development is essential. Recently, the oral microbiome has been implicated as a potential driver and modulating factor of BRONJ by several studies. Modern genomic sequencing methods have provided a wealth of data on the microbial composition of BRONJ lesions; however, the role of individual species in the process of disease development remains elusive. A comprehensive PubMed search was conducted to identify relevant studies on the microbiome of BRONJ patients using the terms "microbiome", "osteonecrosis of the jaws", and "bisphosphonates". Studies focusing on symptoms, epidemiology, pathophysiology, risk factors, and treatment options were included. The principal risk factors for BRONJ are tooth extraction, surgical procedures, and the administration of high doses of bisphosphonates. Importantly, the oral microbiome plays a significant role in the progression of the disease. Several studies have identified alterations of microbial composition in BRONJ lesions. However, there is no consensus regarding bacterial species that are associated with BRONJ across studies. The bacterial genera typically found include Actinomyces, Fusobacterium, and Streptococcus. It is postulated that these microbes contribute to the pathogenesis of BRONJ by promoting inflammation and disrupting normal bone remodeling processes. Current therapeutic approaches are disease-stage-specific and the necessity for more effective treatment strategies remains. This review examines the potential causes of and therapeutic approaches to BRONJ, highlighting the link between microbial colonization and BRONJ development. Future research should seek to more thoroughly investigate the interactions between bisphosphonates, the oral microbiome, and the immune system in order to develop targeted therapies.
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Affiliation(s)
- Sapir Jelin-Uhlig
- German Center for Infection Research (DZIF), Partner Site Giessen-Marburg-Langen, Justus Liebig University Giessen, D-35392 Giessen, Germany; (S.J.-U.); (M.W.); (C.I.)
- Institute of Medical Microbiology, Medical Microbiome-Metagenome Unit (M3U), Justus Liebig University Giessen, D-35392 Giessen, Germany;
| | - Markus Weigel
- German Center for Infection Research (DZIF), Partner Site Giessen-Marburg-Langen, Justus Liebig University Giessen, D-35392 Giessen, Germany; (S.J.-U.); (M.W.); (C.I.)
- Institute of Medical Microbiology, Medical Microbiome-Metagenome Unit (M3U), Justus Liebig University Giessen, D-35392 Giessen, Germany;
| | - Benjamin Ott
- Institute of Medical Microbiology, Medical Microbiome-Metagenome Unit (M3U), Justus Liebig University Giessen, D-35392 Giessen, Germany;
| | - Can Imirzalioglu
- German Center for Infection Research (DZIF), Partner Site Giessen-Marburg-Langen, Justus Liebig University Giessen, D-35392 Giessen, Germany; (S.J.-U.); (M.W.); (C.I.)
- Institute of Medical Microbiology, Medical Microbiome-Metagenome Unit (M3U), Justus Liebig University Giessen, D-35392 Giessen, Germany;
| | - Hans-Peter Howaldt
- Department of Oral and Maxillofacial Surgery, Justus Liebig University Giessen, University Hospital Giessen and Marburg, D-35392 Giessen, Germany; (H.-P.H.); (S.B.)
| | - Sebastian Böttger
- Department of Oral and Maxillofacial Surgery, Justus Liebig University Giessen, University Hospital Giessen and Marburg, D-35392 Giessen, Germany; (H.-P.H.); (S.B.)
| | - Torsten Hain
- German Center for Infection Research (DZIF), Partner Site Giessen-Marburg-Langen, Justus Liebig University Giessen, D-35392 Giessen, Germany; (S.J.-U.); (M.W.); (C.I.)
- Institute of Medical Microbiology, Medical Microbiome-Metagenome Unit (M3U), Justus Liebig University Giessen, D-35392 Giessen, Germany;
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Abstract
PURPOSE OF REVIEW Osteonecrosis of the jaw (ONJ) is a rare and severe necrotic bone disease reflecting a compromise in the body's osseous healing mechanisms and unique to the craniofacial region. Antiresorptive and antiangiogenic medications have been suggested to be associated with the occurrence of ONJ; yet, the pathophysiology of this disease has not been fully elucidated. This article raises the current theories underlying the pathophysiology of ONJ. RECENT FINDINGS The proposed mechanisms highlight the unique localization of ONJ. The evidence-based mechanisms of ONJ pathogenesis include disturbed bone remodeling, inflammation or infection, altered immunity, soft tissue toxicity, and angiogenesis inhibition. The role of dental infections and the oral microbiome is central to ONJ, and systemic conditions such as rheumatoid arthritis and diabetes mellitus contribute through their impact on immune resiliency. Current experimental studies on mechanisms of ONJ are summarized. The definitive pathophysiology is as yet unclear. Recent studies are beginning to clarify the relative importance of the proposed mechanisms. A better understanding of osteoimmunology and the relationship of angiogenesis to the development of ONJ is needed along with detailed studies of the impact of drug holidays on the clinical condition of ONJ.
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Affiliation(s)
- J Chang
- Department of Periodontology, University of Florida College of Dentistry, Gainesville, FL, 32610, USA
| | - A E Hakam
- Department of Periodontology, University of Florida College of Dentistry, Gainesville, FL, 32610, USA
| | - L K McCauley
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, 1011 North University Ave, Ann Arbor, MI, 48109, USA.
- Department of Pathology, Medical School, University of Michigan, Ann Arbor, MI, USA.
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