Current Osteoporosis Reports

, Volume 8, Issue 1, pp 40–48 | Cite as

The Role of Microbial Biofilms in Osteonecrosis of the Jaw Associated with Bisphosphonate Therapy

  • Satish K. S. Kumar
  • Amita Gorur
  • Christoph Schaudinn
  • Charles F. Shuler
  • J. William Costerton
  • Parish P. SedghizadehEmail author


Microbial biofilms have been observed and described in bone specimens of patients with bisphosphonate (BP)-associated osteonecrosis of the jaw (BONJ) and investigators are more recently suggesting that this condition essentially represents an osteomyelitis of the jaw clinically, with greater susceptibility in some patients on BP therapy. This article explains the role of microbial biofilms in BONJ and also discusses associated factors in the disease pathogenesis, which include BP effects on bone remodeling, anti-angiogenesis, matrix necrosis, microcracks, soft tissue toxicity, and inflammation and wound healing. Recent findings suggest a key role for microbial biofilms in the pathogenesis of BONJ; this has important therapeutic implications because biofilm organisms represent a clinical target for prevention and treatment efforts aimed at reducing the significant morbidity and costs associated with this condition.


Bisphosphonate BONJ Osteonecrosis Bone Microcrack Infection 



Owing to journal requirements for references, certain key contributions in the field of BONJ and microbial biofilms may not have been cited in this manuscript and the authors would like to acknowledge all such scientific contributions.


No potential conflicts of interest relevant to this article were reported.


Papers of particular interest, published recently, have been highlighted as follows: •Of importance ••Of major importance

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Satish K. S. Kumar
    • 1
  • Amita Gorur
    • 2
  • Christoph Schaudinn
    • 2
  • Charles F. Shuler
    • 3
  • J. William Costerton
    • 4
  • Parish P. Sedghizadeh
    • 5
    Email author
  1. 1.Clinical Dentistry, Orofacial Pain and Oral Medicine Center, Division of Diagnostic Sciences, School of DentistryUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Center for Biofilms, School of DentistryUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.School of DentistryUniversity of British ColumbiaVancouverCanada
  4. 4.Microbiology Research, Department of Orthopedic Surgery, Allegheny General Hospital and Center for GenomicsAllegheny-Singer Research InstitutePittsburghUSA
  5. 5.USC School of Dentistry, Center for BiofilmsLos AngelesUSA

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