ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2026
Actinomyces lesions and acute inflammation predominate in osteonecrosis of the jaw associated with osteoclast-suppressing therapy in contrast to non-medication-related osteonecrosis.
Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposePatients receiving antiresorptive therapy for cancer bone metastases/lesions or osteoporosis may develop osteonecrosis of the jaw. The pathogenesis remains unclear, but the condition has been associated with Actinomyces, co-pathogens, and pro-inflammatory activity. However, there are limited studies comparing these factors between medication-related osteonecrosis and non-medication-related osteonecrosis.
methodsThis is a single-centre retrospective study of 98 patients with jawbone biopsies due to medication-related osteonecrosis treated with bisphosphonates and/or denosumab, and 93 patients with non-medication-related osteonecrosis during 2002-2020. We reviewed their medical records and analysed tissue samples for Actinomyces colonies, inflammation and proinflammatory collagenase matrix metalloproteinase-8 (MMP-8) using immunohistochemistry.
resultsActinomyces colonies were more prevalent in medication-related osteonecrosis (85%) compared to non-medication-related cases (51%; p < 0.001) and were mainly associated with necrotic bone. Inflammation was present in most samples; however, in medication-related osteonecrosis, it was predominantly acute (58%) and rarely chronic (5%), whereas in non-medication-related biopsies, inflammation was acute in 38% and chronic in 27% of biopsies (p < 0.001). Enhanced MMP-8 immunoreactivity was observed in 61% of medication-related osteonecrosis vs. 38% in non-medication-related biopsies (p = 0.002), and MMP-8 was especially expressed alongside actinomycotic lesions (57% vs. 34%; p < 0.001). In multivariable logistic regression, the medication-related group was independently associated with a higher prevalence of Actinomyces colonies.
conclusionMedication-related osteonecrosis was independently linked to a higher prevalence of Actinomyces compared to non-medication-related osteonecrosis. Furthermore, acute inflammation and collagenase activity seemed to be effects of Actinomyces-associated infection. The presence of Actinomyces may suggest immunological differences between these osteonecrosis types.
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