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Abstract：
Medication-related osteonecrosis of the jaw (MRONJ) is an increasingly common consequence of antiresorptive treatment, which often leads to the development of necrotic exposed bone surfaces with inflammatory processes affecting the jawbone. Although the development of MRONJ is often associated with the inflammatory response or infections caused by the colonizing members of the oral microbiota, the exact pathogenesis of MRONJ is still not fully understood. In the present paper, we aimed to provide additional, microbiological culture-supported evidence, supporting the \"infection hypothesis\" that Actinomyces spp. and related organisms may play an important pathogenic role in the development of MRONJ and the resulting bone necrosis. In our case series, all patients presented with similar underlying conditions and anamnestic data, and have received antiresorptive medications (bisphosphonates or a RANK ligand (RANKL) inhibitor) to prevent the occurrence or progression of bone metastases, secondary to prostate cancer. Nevertheless, a few years into antiresorptive drug therapy, varying stages of MRONJ was identified in the mentioned patients. In all three cases, quantitative microbiological culture of the necrotic bone samples yielded a complex microbiota, dominated by Actinomyces and Schaalia spp. with high colony counts. Additionally, our followed-up case series document the treatment of these patients with a combination of surgical intervention and long-term antibiotic therapy, where favourable clinical responses were seen is all cases. If the \"infection hypothesis\" is valid, it may have significant consequences in the preventative and therapeutic strategies associated with this disease.
摘要：
药物相关的颌骨坏死（MRONJ）是抗再吸收治疗的越来越常见的后果，这通常导致坏死的暴露骨表面的发展，炎症过程影响颌骨。尽管MRONJ的发展通常与口腔微生物群的定殖成员引起的炎症反应或感染有关，MRONJ的确切发病机制尚不完全清楚。在本论文中，我们的目标是提供额外的，微生物培养支持的证据，支持放线菌属的“感染假说”。相关生物可能在MRONJ的发育和由此导致的骨坏死中起重要的致病作用。在我们的案例系列中，所有患者都有相似的潜在疾病和记忆数据，并已接受抗再吸收药物（双膦酸盐或RANK配体（RANKL）抑制剂）以预防骨转移的发生或进展，继发于前列腺癌.然而，抗吸收药物治疗几年后，在上述患者中发现了不同阶段的MRONJ.在这三种情况下，坏死骨样品的定量微生物培养产生了复杂的微生物群，以放线菌和Schaalia属为主。殖民地数量高。此外,我们的随访病例系列记录了手术干预和长期抗生素治疗相结合对这些患者的治疗，观察到良好的临床反应的是所有病例。如果“感染假设”是有效的，它可能对与该疾病相关的预防和治疗策略产生重大影响。
