Inhibition of oral mucosal cell wound healing by bisphosphonates

J Oral Maxillofac Surg. 2008 May;66(5):839-47. doi: 10.1016/j.joms.2008.01.026.


Purpose: Bisphosphonates (BPs) are a widely used class of drugs that are effective in the treatment and prevention of osteoporosis, hypercalcemia of malignancy, and bone metastases associated with multiple myeloma, breast cancer, and other solid tumors. In the past several years there have been numerous reports describing the occurrence of osteonecrosis of the jaws (ONJ) associated with these drugs. Whether the ONJ lesion initiates in the oral mucosa or derives from the underlying bone is not well understood. In this report we describe the effect of pamidronate, a second-generation BP, on oral mucosal cells.

Materials and methods: Murine oral keratinocytes were isolated and exposed to pamidronate at a range of clinically relevant doses. Cellular proliferation was measured using a MTS/PMS reagent-based kit and wound healing was examined with a scratch assay. To determine whether oral keratinocytes undergo apoptosis following exposure to pamidronate, TUNEL, caspase-3, and DAPI apoptosis assays were performed.

Results: We show that BP pretreatment of oral mucosal cells inhibits proliferation and wound healing at clinically relevant doses, and that this inhibition is not due to cellular apoptosis.

Conclusions: To our knowledge this is the first report investigating the effect of nitrogen-containing BPs on oral mucosal cells. This study suggests that BPs inhibit oral keratinocyte wound healing which may play a significant role in the initiation of ONJ.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Animals
  • Apoptosis
  • Bone Density Conservation Agents / chemistry
  • Bone Density Conservation Agents / toxicity*
  • Caspase 3 / metabolism
  • Cell Proliferation / drug effects
  • Cells, Cultured
  • Diphosphonates / chemistry
  • Diphosphonates / toxicity*
  • Fluorescent Dyes / metabolism
  • In Situ Nick-End Labeling
  • Indoles / metabolism
  • Jaw Diseases / chemically induced
  • Keratinocytes / drug effects
  • Keratinocytes / enzymology
  • Mice
  • Mouth Mucosa / drug effects*
  • Mouth Mucosa / enzymology
  • Nitrogen
  • Osteonecrosis / chemically induced
  • Pamidronate
  • Wound Healing / drug effects*


  • Bone Density Conservation Agents
  • Diphosphonates
  • Fluorescent Dyes
  • Indoles
  • DAPI
  • Caspase 3
  • Nitrogen
  • Pamidronate