Investigating the effect of vitamin D3 (1,25(OH)2D3) (Calcitriol) on the osteonecrosis of bone induced after tooth extraction on the rats have given zoledronic acid (Zometa)

Bisphosphonates (BPs) are pharmaceutical agents that used in the treatment of many bone disorders such as osteoporosis, bone metastases and multiple myeloma. Zoledronic acid is the most potent molecule and it is used commonly treatment of these diseases. BRONJ is a pathological complication resulting bone necrosis that associated with the use of bisphosphonates and enconter in jaws. Vitamin D is one of the most important physiological regulators of bone homeostasis via regulating calcium and phosphorous metabolism, and regulating this metabolism has an effect on the parathyroid glands, the bones, the intestines, and the kidneys. The purpose of this study,investigate the efficacy of 1,25(OH)2D3 on treatment of BRONJ which induce systemic administration of zoledronic acid. In the study, ninety, 5 months old, male, Wistar albino rats were used. The animals were divided into five groups; a control group, three study groups, and a sham group. All animals except the sham group, osteonecrosis (BRONJ) was created in the upper jaw. Vitamin D3 was given study groups preoperatively, postoperatively, and after the osteonecrosis. All the animals were sacrificed as follows at the 10th,15th, and 17th weeks. Blood samples were taken from all the subjects for biochemical analysis and specimen was taken from maxillary bone for histopathological studies. histopathological and biochemical analyzes were performed.The control-15 group had a lower N-telopeptide (NTX) level, which was statistically significant compared to the postoperative-15 (p=0.050) and the sham (p=0.008) groups. The NTX levels were significantly higher in the sham group in comparison to the control-17 (p=0.020) group and the osteonecrosis-17 (p=0.034) group. The preoperative-15 group showed significantly higher vitamin D levels compared with the postoperative-15 (p=0.032) group, the control-15 (p=0.006) group, and the sham (p=0.012) group. The postoperative-10 group showed significantly higher calcium levels in comparison to the preoperative-10 (p=0.012) group and the control-10 (p=0.019) group; moreover, the calcium levels were significantly higher in the osteonecrosis-17 group in comparison to the control-17 (p=0.001) group and the sham (p=0.002) group. The CTX levels were not statistically significant in all the groups that were sacrificed at the 10th, 15th, and 17th weeks. This same tendency was observed for the alkaline phosphatase (ALP) and osteocalcin parameters. The postoperative-15 group had a lower osteoblast number, which was statistically significant as compared to the preoperative-15 (p=0.001) and control-15 (p=0.002) group. The control-10 group showed significantly lower osteoclast number in comparison to the preoperative-10 (p=0.010) and postoperative-10 (p=0.026) group. The osteoclast number was significantly higher in the osteonecrosis-17 (p=0.023) group as compared to the control-17. The preoperative-10 group showed significantly higher inflammation in comparison to the control-10 group (p=0.025). The postoperative-15 group had a lower histologic osteonecrosis, which was statistically significant as compared to the control-15 (p=0.034) group. The macroscopic osteonecrosis was significantly higher in the control-17 group in comparison to the osteonecrosis-17 (p=0.011) group.