Analysis of the microbial picture in medication-related osteonecrosisof the jaws

   Medication-related osteonecrosis of the jaws is an extremely severe complication that occurs after taking bisphosphonates, particularly zoledronic acid. Many studies have shown that oral microorganisms play a significant role in the pathogenesis and development of the inflammatory process associated with this complication. Actinomycetes are frequently detected in bone samples from patients with this condition. This article analyzes the results of a microbiological study in patients with medication-related osteonecrosis of the jaws, comparing them to post-traumatic osteomyelitis and chronic odontogenic osteomyelitis. Data on the susceptibility of microorganisms to various antibacterial agents are also analyzed. It has been established that medication-related osteonecrosis of the jaws is characterized by a wide diversity of microorganisms, including Streptococcus viridans, Staphylococcus aureus, Actinomyces species, and a number of other representatives of the oral microflora. The microbial picture in drug-induced osteonecrosis of the jaws has features of both odontogenic and stomatogenic processes. The presence of actinomycetes likely aligns it with the odontogenic type. Due to the difficulties in culturing actinomycetes, preliminary microscopy to detect mycelium and pathohistological methods are preferred for their diagnosis. In drug-induced osteonecrosis of the jaws, Staphylococcus aureus is resistant to cephalosporin antibiotics; second-generation fluoroquinolones (ciprofloxacin, levofloxacin) have proven most effective. When Streptococcus viridans was detected in cultures from patients with drug-induced osteonecrosis of the jaws, penicillin and second- to fourth-generation cephalosporins, as well as doxycycline, were the most effective antibacterial agents. The presence of actinomycetes in the pathogenesis of drug-induced osteonecrosis of the jaws has been confirmed and requires further study.

1. Ruggiero S.L., Dodson T.B., Aghaloo T., Carlson E.R., Ward B.B., Kademani D. American Association of Oral and Maxillofacial Surgeons’ Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update. – J. Oral Maxillofac. Surg. 2022;80(5):920–943. doi: 10.1016/j.joms.2022.02.008.

2. Limones A., Sáez-Alcaide L.M., Díaz-Parreño S.A., Helm A., Bornstein M.M., Molinero-Mourelle P. Medication-related osteonecrosis of the jaws (MRONJ) in cancer patients treated with denosumab VS. zoledronic acid: A systematic review and meta-analysis. Med. Oral Patol. Oral Cir. Bucal. 2020;25(3):326–336. doi: 10.4317/medoral.23324.

3. Melnikova S.Yu., Popovich Ya.A., Spevak E.M., Khristoforando D.Yu. Frequency of occurrence of bisphosphonate osteonecrosis (analysis of archival data). International Student Scientific Bulletin. 2016;4(1):120–121. (In Russ.)

4. Khryachkov V.I., Andreev A.A., Stepanov I.V., Podoprigora A.V., Khodorkovsky M.M., Stepanova E.S. Experience in the treatment of chronic odontogenic osteomyelitis of the lower jaw in a surgical hospital. Actual problems in dentistry. 2021;1:99–105. (In Russ.) doi: 10.18481/2077-7566-20-17-1-99-105.

5. Halim H.E.A., Gavrilov V.A. Modern ideas about chronic odontogenic osteomy-elitis of the lower jaw (literature review). General Pathology and pathological physiology. 2013;8(3):32–43. (In Russ.)

6. Khramova, N. V. N. Analysis of complications in fractures of the lower jaw. European Science. 2020; 5(54): 52-55. doi: 10.24411/2410-2865-2020-10502. (In Russ.)

7. Kononenko V.I., Klimenko A.V., Neykovskaya E.V., Ebzeev A.K. Analysis of the clinical course of chronic post-traumatic osteomyelitis of the lower jaw in patients with chronic viral hepatitis С. Chief Physician of the South of Russia. 2013;6(37): 30–31. (In Russ.)

8. Polyakov K.A., Ivanyushko T.P., Arazashvili L.D., Medvedev Yu.A., Trofimov D.Yu., Abramov D.D., Korshunova A.V., Obraztsova T.A. The importance of conditionally pathogenic microflora in the development of osteonecrosis of the jaw. Head and neck = Head and neck. Russian Journal. 2018;6(2):15–19. (In Russ.) doi: 10.25792/HN.2018.6.2.15-19.

9. Tsarev V.N., Davydova M.M., Nikolaeva E.N. [et al.]; Team of authors. Microbiology, virology and immunology of the oral cavity. Moscow: GEOTAR-Media Publishing Group Limited Liability Company, 2013;49–64. ISBN 978-5-9704-2582-4. (In Russ.)

10. Kövér Z., Bán Á., Gajdács M., Polgár B., Urbán E. Role of Actinomyces spp. and related organisms in the development of medication-related osteonecrosis of the jaw (MRONJ): Clinical evidence based on a case series. Eur. J. Microbiol. Immunol (Bp). 2023;13(4):125–134. doi: 10.1556/1886.2023.00041.

11. Bilgilier C., Fuereder T., Kastner M.T., Vass Z., Brandl I., Sahbegovic H., Singer C.F., Steininger C. Oral Abundance of Actinomyces spp. in Breast Cancer Patients. Oncology. 2022;100(4):221–227. doi: 10.1159/000522070.

12. Brody A., Scheich B., Dobo-Nagy C. Targeted histological evaluation shows high incidence of actinomyces infection in medication-related osteonecrosis of the jaws. Sci Rep. 2022;12(1):3406. doi: 10.1038/s41598-022-07375-1.