Matrix-bound zolzoledronate enhances the biofilm colonization of hydroxyapatite: Effects on osteonecrosis

Ranya Elsayed, Ahmed El-Awady, Christopher Cutler, Zoya Kurago, Mahmoud Elashiry, Christina Sun, Ryan Bloomquist, Mohamed M. Meghil, Mohammed E. Elsalanty

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


(1) Background: The aim of this study was to test whether matrix-bound zoledronate (zol) molecules enhanced the oral biofilm colonization of a mineralized matrix, rendering the alveolar bone more susceptible to medication-related osteonecrosis of the jaw (MRONJ) following invasive dental procedures. (2) Methods: We tested the effect of matrix-bound zol on the growth and attachment of Porphyromonas gingivalis (Pg), Fusobacterium nucleatum (Fn) and Actinomyces israelii (Ai), and whether the nitrogen-containing component of zol contributed to such effect. The role of oral bacteria in the induction of osteonecrosis was then tested using an extra-oral bone defect model. (3) Results: The attachment of biofilm to hydroxyapatite discs increased when the discs were pre-treated with zol. Bacterial proliferation was not affected. Matrix-bound zol was more potent than non-nitrogen-containing etidronate in enhancing the colonization. Stimulation was dampened by pre-treating the bacteria with histidine. The delivery of oral biofilm to a tibial defect caused osteonecrosis in zol-treated rats. (4) Conclusions: We conclude that matrix-bound zol enhances the oral biofilm colonization of hydroxyapatite. This enhancement depended on the presence of the nitrogen-containing group. The oral biofilm rendered the extra-oral bone susceptible to medication-related osteonecrosis, suggesting that it has an important role in the induction of MRONJ.

Original languageEnglish (US)
Article number1380
Issue number11
StatePublished - Nov 2021


  • Antiresorptive
  • Biofilm
  • Bisphosphonates
  • Oral bacteria
  • Osteonecrosis
  • Osteoporosis
  • Zoledronates

ASJC Scopus subject areas

  • Microbiology
  • Biochemistry
  • Pharmacology, Toxicology and Pharmaceutics(all)
  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)


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