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The pathogenesis remains unclear, but the condition has been associated with\n                      <jats:italic>Actinomyces<\/jats:italic>\n                      , co-pathogens, and pro-inflammatory activity. However, there are limited studies comparing these factors between medication-related osteonecrosis and non-medication-related osteonecrosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This 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\u20132020. We reviewed their medical records and analysed tissue samples for\n                      <jats:italic>Actinomyces<\/jats:italic>\n                      colonies, inflammation and proinflammatory collagenase matrix metalloproteinase-8 (MMP-8) using immunohistochemistry.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Actinomyces<\/jats:italic>\n                      colonies were more prevalent in medication-related osteonecrosis (85%) compared to non-medication-related cases (51%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) 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 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Enhanced MMP-8 immunoreactivity was observed in 61% of medication-related osteonecrosis vs. 38% in non-medication-related biopsies (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002), and MMP-8 was especially expressed alongside actinomycotic lesions (57% vs. 34%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In multivariable logistic regression, the medication-related group was independently associated with a higher prevalence of\n                      <jats:italic>Actinomyces<\/jats:italic>\n                      colonies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Medication-related osteonecrosis was independently linked to a higher prevalence of\n                      <jats:italic>Actinomyces<\/jats:italic>\n                      compared to non-medication-related osteonecrosis. Furthermore, acute inflammation and collagenase activity seemed to be effects of\n                      <jats:italic>Actinomyces<\/jats:italic>\n                      -associated infection. The presence of\n                      <jats:italic>Actinomyces<\/jats:italic>\n                      may suggest immunological differences between these osteonecrosis types.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10096-026-05501-9","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T03:49:19Z","timestamp":1775447359000},"page":"2105-2117","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Actinomyces lesions and acute inflammation predominate in osteonecrosis of the jaw associated with osteoclast-suppressing therapy in contrast to non-medication-related osteonecrosis"],"prefix":"10.1007","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-1245-3071","authenticated-orcid":false,"given":"Marjo","family":"Kivel\u00e4-Rajam\u00e4ki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"V\u00e4limaa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jussi","family":"Furuholm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caj","family":"Haglund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Sorsa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaana","family":"Hagstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asko","family":"J\u00e4rvinen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,6]]},"reference":[{"key":"5501_CR1","doi-asserted-by":"publisher","first-page":"1441","DOI":"10.1210\/clinem\/dgab888","volume":"107","author":"AD Anastasilakis","year":"2022","unstructured":"Anastasilakis AD, Pepe J, Napoli N, Palermo A, Magopoulos C, Khan AA, Zillikens MC, Body J-J (2022) Osteonecrosis of the Jaw and Antiresorptive Agents in Benign and Malignant Diseases: A Critical Review Organised by the ECTS. 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