tetracycline and Osteonecrosis

To date, the therapy of bisphosphonate-associated osteonecrosis of the jaws (BONJ) has been hampered by the lack of imaging modalities that enable the extent of necrosis to be visualized. This study aims to demonstrate the feasibility of tetracycline fluorescence guided bone resection in the surgical management of BONJ.. Following a 10-day preoperative administration of doxycycline in patients suffering from BONJ, sufficient doxycycline is incorporated into viable bone to be visualized with a certified medical lamp emitting exciting light at 400 to 460 nm.. Viable and necrotic bone can be discriminated intraoperatively in a routine and reproducible manner by doxycycline bone fluorescence.. In the therapy of BONJ, conservative concepts are to be favored. The fact that necrotic bone can now be selectively resected signifies an improvement of the conservative surgical therapy of BONJ.

Topics: Aged; Bone Density Conservation Agents; Cone-Beam Computed Tomography; Diphosphonates; Feasibility Studies; Female; Fluorescence; Fluorometry; Humans; Jaw Diseases; Light; Male; Oral Surgical Procedures; Orthognathic Surgical Procedures; Osteonecrosis; Tetracycline

Topics: Bone Density Conservation Agents; Cone-Beam Computed Tomography; Diphosphonates; Fluorescent Dyes; Humans; Jaw Diseases; Osteonecrosis; Tetracycline

Osteonecrosis of the jaws (ONJ) associated with bisphosphonate therapy is being reported with increasing frequency all over the world. Pain may be the presenting symptom commonly associated with intra-oral bone exposure. The aetiology of this therapeutic complication is still not well understood. Three cases are presented and the management of the condition is discussed.

Topics: Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bone Density Conservation Agents; Chlorhexidine; Diphosphonates; Facial Pain; Female; Humans; Imidazoles; Jaw Diseases; Male; Middle Aged; Osteonecrosis; Osteoporosis, Postmenopausal; Tetracycline; Zoledronic Acid

The authors have found that several months of preoperative tetracycline administration will label living bone so that it fluoresces under a blacklight during surgery. This allows intraoperative differentiation of viable bone from necrotic sequestra, which require removal in the treatment of chronic bone infection.

Topics: Chronic Disease; Debridement; Fluorescence; Humans; Indicators and Reagents; Osteomyelitis; Osteonecrosis; Preoperative Care; Sensitivity and Specificity; Tetracycline

We studied the bone histology by histomorphometric methods in transiliac bone-biopsy specimens from seventy-seven adult patients with aseptic osteonecrosis and normal kidney function. The trabecular bone volume, trabecular osteoid volume, trabecular osteoid surfaces, thickness index of osteoid seams, total resorption surfaces, calcification rate, tetracycline-labeled surfaces, and bone-formation rate at the basic multicellular unit level and at the tissue level were determined. Histological evidence of osteomalacia was found in nine patients, of whom four were alcoholics. In the remaining sixty-eight patients--fifteen treated with corticosteroids, twenty-nine alcoholics, and twenty-four who did not have any detectable etiological factor--a common histomorphometric profile was found. This consisted morphologically of a reduction in trabecular bone volume and in the thickness of osteoid seams, and dynamically of a reduction in calcification rate and in total labeled surfaces. All of these changes suggested a marked decrease in osteoblastic appositional rate and in bone-formation rate at the cell and tissue levels. This could induce a healing defect of microfractures and thus facilitate subchondral fractures.. This histological study indicated that non-apparent bone disease--either osteoporosis or osteomalacia--may underlie aseptic osteonecrosis in almost all patients, and be found even when blood and urinary biochemical parameters, usually reflecting bone-remodeling, are normal. An iliac-crest bone biopsy with static and dynamic histomorphometric study is the appropriate method for detecting these abnormalities. These results are of importance for understanding the pathophysiological mechanisms underlying osteonecrosis as well as its prevention and treatment.

Topics: Adult; Aged; Biopsy; Calcification, Physiologic; Female; Histological Techniques; Humans; Ilium; Male; Middle Aged; Osteogenesis; Osteomalacia; Osteonecrosis; Tetracycline