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Increased prevalence of bisphosphonate-related osteonecrosis of the jaw with vitamin D deficiency in rats

  1. Akishige Hokugo1,
  2. Russell Christensen2,
  3. Evelyn M Chung1,3,
  4. Eric C Sung1,3,
  5. Alan L Felsenfeld4,
  6. James W Sayre5,
  7. Neal Garrett1,
  8. John S Adams6,
  9. Ichiro Nishimura1,*

Article first published online: 14 JAN 2010

DOI: 10.1002/jbmr.23

Issue

Journal of Bone and Mineral Research

Journal of Bone and Mineral Research

Volume 25, Issue 6, pages 1337–1349, June 2010

Additional Information

How to Cite

Hokugo, A., Christensen, R., Chung, E. M., Sung, E. C., Felsenfeld, A. L., Sayre, J. W., Garrett, N., Adams, J. S. and Nishimura, I. (2010), Increased prevalence of bisphosphonate-related osteonecrosis of the jaw with vitamin D deficiency in rats. J Bone Miner Res, 25: 1337–1349. doi: 10.1002/jbmr.23

Author Information

  1. 1

    The Jane and Jerry Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Los Angeles, CA, USA

  2. 2

    Section of Oral and Maxillofacial Pathology, UCLA School of Dentistry, Los Angeles, CA, USA

  3. 3

    Section of Hospital Dentistry, UCLA School of Dentistry, Los Angeles, CA, USA

  4. 4

    Section of Oral and Maxillofacial Surgery, UCLA School of Dentistry, Los Angeles, CA, USA

  5. 5

    Department of Biostatistics, UCLA School of Public Health, Los Angeles, CA, USA

  6. 6

    The Orthopedic Hospital Musculoskeletal Research Institute, The David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

*The Weintraub Center for Reconstructive Biotechnology, UCLA School of Dentistry, Box 951668, CHS B3-087, Los Angeles, CA 90095-1668, USA.

Publication History

  1. Issue published online: 27 MAY 2010
  2. Article first published online: 14 JAN 2010
  3. Accepted manuscript online: 14 JAN 2010 12:00AM EST
  4. Manuscript Accepted: 29 DEC 2009
  5. Manuscript Revised: 9 NOV 2009
  6. Manuscript Received: 8 APR 2009

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Keywords:

  • osteonecrosis of the jaw;
  • bisphosphonates;
  • vitamin D deficiency;
  • hyperparathyroidism;
  • innate immunity

Abstract

Necrotic bone exposure in the oral cavity has recently been reported in patients treated with nitrogen-containing bisphosphonates as part of their therapeutic regimen for multiple myeloma or metastatic cancers to bone. It has been postulated that systemic conditions associated with cancer patients combined with tooth extraction may increase the risk of osteonecrosis of the jaw (ONJ). The objective of this study was to establish an animal model of bisphosphonate-related ONJ by testing the combination of these risk factors. The generation of ONJ lesions in rats resembling human disease was achieved under the confluence of intravenous injection of zoledronate (ZOL; 35 µg/kg every 2 weeks), maxillary molar extraction, and vitamin D deficiency [VitD(−)]. The prevalence of ONJ in the VitD(−)/ZOL group was 66.7%, which was significantly higher (p < .05, Fisher exact test) than the control (0%), VitD(−) (0%), and ZOL alone (14.3%) groups. Similar to human patients, rat ONJ lesions prolonged the oral exposure of necrotic bone sequestra and were uniquely associated with pseudoepitheliomatous hyperplasia. The number of terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate–biotin nick-end label–positive (TUNEL+) osteoclasts significantly increased on the surface of post–tooth extraction alveolar bone of the VitD(−)/ZOL group, where sustained inflammation was depicted by [18F]fluorodeoxyglucose micro-positron emission tomography (µPET). ONJ lesions were found to be associated with dense accumulation of mixed inflammatory/immune cells. These cells, composed of neutrophils and lymphocytes, appeared to juxtapose apoptotic osteoclasts. It is suggested that the pathophysiologic mechanism(s) underpinning ONJ may involve the interaction between bisphosphonates and compromised vitamin D functions in the realm of skeletal homeostasis and innate immunity. © 2010 American Society for Bone and Mineral Research

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