Comparison of clinical effectiveness of single and multiple applications of 1% chlorhexidine varnish (Cervitec Plus) along with scaling and root planing in patients with chronic periodontitis.

BACKGROUND: Local drug delivery is most commonly used as an adjunct to scaling and root planing (SRP) for the treatment of periodontal disease. Varied success rates have been documented for various vehicles used for intrasite delivery of active therapeutic agents. Recently, varnishes acting as a reservoir of chlorhexidine have shown potential for the management of chronic periodontitis patients. The aim of the present investigation was a comparative evaluation of the clinical effectiveness of single and multiple applications of 1% chlorhexidine and thymol varnish (Cervitec Plus) along with SRP in patients with chronic periodontitis. MATERIALS AND METHODS: The present study included 30 patients with chronic periodontitis divided into three groups based on the number of subgingival applications of chlorhexidine varnish single application (Group A), two applications at a week's interval (Group B), and three applications with 7-day interval in between two applications (Group C). Clinical parameters, namely plaque index (PI), sulcus bleeding index, probing pocket depth (PPD), and relative attachment level (RAL) were recorded at baseline, 1 month and 3 months in all three groups to compare the clinical efficacy. RESULTS: A statistically significant reduction was observed in PI, sulcus bleeding index, PPD, and RAL at 1 and 3 months in all the three groups. Greater (though statistically nonsignificant) improvements were observed in Groups B and C. CONCLUSION: Within limitations of the study, it can be concluded that multiple applications of 1% chlorhexidine and thymol varnish (Cervitec Plus) have an added benefit over the single application in the treatment of chronic periodontitis.

Cysteine-rich low molecular weight antimicrobial peptides from Brevibacillus and related genera for biotechnological applications.

The production of natural antimicrobial peptides (AMPs) is an innate immunity trait of all life forms including eukaryotes and prokaryotes. While these AMPs are usually called as defensins in eukaryotes, they are known as bacteriocins in prokaryotes. Bacteriocins are more diverse AMPs considering their varied composition and posttranslational modifications. Accordingly, this review is focused on cysteine-rich AMPs resembling eukaryotic defensins such as laterosporulin from Brevibacillus spp. and associated peptides secreted by the members of related genera. In fact, structural studies of laterosporulin showed the pattern typically observed in human defensins and therefore, should be considered as bacterial defensin. Although the biosynthesis mechanism of bacterial defensins displayed high similarities, variations in amino acid composition and structure provided the molecular basis for a better understanding of their properties. They are reported to inhibit Gram-positive, Gram-negative, non-multiplying and human pathogenic bacteria. The extreme stability is due to the presence of intra-molecular disulfide bonds in prokaryotic defensins and reveals their potential clinical and food preservation applications. Notably, they are also reported to have potential anticancer properties. Therefore, this review is focused on multitude of diverse applications of bacterial defensins, exploring the possible correlations between their structural, functional and possible biotechnological applications.

Clinical and Microbiological Investigation of the Effects of Probiotics Combined with Scaling and Root Planing in the Management of Chronic Periodontitis: A Randomized, Controlled Study.

AIM: To assess the adjunctive effect of probiotics to scaling and root planing in the management of chronic periodontitis. MATERIALS AND METHODS: Thirty systemically healthy subjects in the age range of 20 - 55 years suffering from chronic generalized periodontitis were selected and randomly assigned to a control group of patients who received scaling and root planing (SRP) alone, or a test group of patients who received SRP supplemented with probiotic administration, i.e., Bifilac lozenges. The following baseline clinical parameters were recorded at selected teeth: plaque index, gingival index, probing pocket depth and relative attachment level. Microbiological counts of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia were assessed in pooled subgingival plaque samples. The parameters were recorded again at 30 days, 45 days and 3 months from baseline. RESULTS: Statistically significant reductions were observed for plaque index, gingival index, and probing pocket depth, and a significant gain in relative attachment level in both groups. Microbiological analysis showed significant reduction for P. gingivalis at all recall intervals in the test group compared to controls. The intergroup comparison for differences in mean counts of P. gingivalis was found to be significant for the test group at 3 months (p = 0.028). CONCLUSION: Probiotics can be considered as a potentially safe and effective adjunct to scaling and root planing in the management of chronic periodontitis.

Oral Health Knowledge, Attitudes and Practice Behaviour among Secondary School Children in Chandigarh.

INTRODUCTION: Oral health knowledge is considered to be an essential prerequisite for health-related practices and better oral health. Healthy practices adopted at young age are more sustainable. AIM: Present cross-sectional exploratory study was planned to assess oral health knowledge and practices of secondary school students in Chandigarh, India. MATERIALS AND METHODS: A cross-sectional survey was under-taken amongst 1027 secondary level school students, in Chandigarh, India. After obtaining informed consent subjects were administered pretested self administered questionnaire addressing demographics, knowledge, attitude and practice behaviour of participants. Frequency analysis was done using descriptive statistics. RESULTS: Survey revealed that only 40% subjects brushed twice daily. About 17% reported use of dental floss and 20% used either mouthwash or tongue cleaner as adjuncts. A total of 58% had knowledge that infrequent brushing led to dental caries, staining of teeth, dental plaque and bleeding from gums. Most of them knew sweets (92.7%) and soft drinks (67.8%) affected dental health. Only 12.9% visited dentist regularly after every 6-12 months. CONCLUSION: Efficacy of dental health education can be increased only if health programs are tailored to directly impinge on attitudes of targeted population, especially school children in whom healthy practices can be inculcated easily and be sustained for long times.

Correlation of alkaline phosphatase activity to clinical parameters of inflammation in smokers suffering from chronic periodontitis.

CONTEXT: Current clinical periodontal diagnostic techniques emphasize the assessment of clinical and radiographic signs of periodontal diseases which can provide a measure of history of disease. Hence, new methodologies for early identification and determination of periodontal disease activity need to be explored which will eventually result in expedited treatment. AIM: To evaluate the correlation of alkaline phosphatase (ALP) activity in gingival crevicular fluid (GCF) to clinical parameters of periodontal inflammation in smokers with chronic periodontitis. MATERIALS AND METHODS: Study population included 15 smoker male patients in the age group of 35-55 years suffering from moderate generalized chronic periodontitis with history of smoking present. Following parameters were evaluated at baseline, 1 month and 3 months after scaling and root planing: plaque index, bleeding index, probing pocket depth (PD), relative attachment level (RAL), and GCF ALP activity. STATISTICAL ANALYSIS USED: Independent variables for measurements over time were analyzed by using Wilcoxon signed rank test. RESULTS: A statistically significant reduction in all the clinical parameters and GCF ALP activity was observed from baseline to 1 month and 3 months. A correlation was observed between change in GCF ALP activity and PD reduction as well as gain in RAL at 3 months. CONCLUSION: The present study emphasizes that total ALP activity could be used as a marker for periodontal disease activity in smokers. Estimation of changes in the levels of this enzyme has a potential to aid in the detection of progression of periodontal disease and monitoring the response to periodontal therapy.

The Gender Bender effect in Periodontal Immune Response.

BACKGROUND: The gender and sex of an individual is known to have a significant bearing on the immune system, responsible for protection against infections and disease. Contemporary evidence suggests there exists a sexual dimorphism in the hetero immune as well as autoimmune responses in human beings and females show stronger and more vigorous immune responses to antigenic stimulations, e.g infectious diseases and vaccination. The evidence supportive to gender based heterogeneity in immune responses specifically in context of periodontal disease, is mounting in contemporary literature. METHOD: A thorough and methodical search for related scientific publications have been accomplished by using different key words and terms like sex or gender based immune differences in periodontal disease, both by manual methods and on various electronic databases. Primary research articles, narrative and systematic reviews of good quality, relevant to the subject were included. RESULTS: The aggregate effects of the factors related to gender such as the steroid hormones as well as gene based differences in both sexes as supported by published literature are in line with the observed variation in susceptibility for chronic periodontitis in both genders , with males showing more risk for disease than women. CONCLUSION: Gender as a risk factor for periodontal disease needs to identified, its underlying mechanisms to contribute needs to be revealed, so that novel strategies for risk assessment, disease identification and individualized therapeutic approaches can be developed for optimized patient care.

Comparative evaluation of gingival trauma by Prophy-Jet and rubber-cup polishing techniques using aluminium trihydroxide.

OBJECTIVE: The aim of the present study was to compare the gingival trauma with Prophy-Jet and rubber-cup polishing techniques using aluminium trihydroxide as polishing agent. MATERIALS AND METHODS: 15 subjects suffering from gingivitis were enrolled in a randomized controlled split mouth experimental investigation. After scaling, Prophy-Jet and rubber-cup polishing techniques were applied on either side of the mouth using aluminium trihydroxide as polishing agent and the gingival trauma was assessed immediately after, 7 days and 21 days posttreatment using trauma index (TI). RESULTS: Statistically significant difference was observed in the mean TI scores of gingiva immediately after polishing with the two techniques, with the mean score of 0.25 ± 0.12 after rubber-cup and 0.40 ± 0.11 after prophy- jet polishing technique. CONCLUSION: Within the limitations of the study, it can be concluded that inspite of higher gingival trauma immediately after air polishing using aluminium trihydroxide agent, there was no lasting difference in gingival trauma between rubber-cup and air-polishing techniques at 7 and 21 days posttreatment.

Evaluation of OSSIFI® as Alloplastic Bone Graft Material in Treatment of Periodontal Infrabony Defects.

INTRODUCTION: The shift in therapeutic concepts from resection to regeneration has significantly impacted the practice of periodontology. Human studies have revealed that hydroxyapatite bone cement holds great promise as a grafting alloplastic material. AIMS AND OBJECTIVES: To evaluate the efficacy of OSSIFI(®) (combined beta tricalcium phosphate plus hydroxyapatite) in the treatment of periodontal infrabony defects. MATERIALS AND METHODS: Ten study subjects were selected and divided into two groups. Group I (PD>7mm) and Group II (PD≤ 7mm). Both Groups I and II were treated by regenerative periodontal surgery using OSSIFI(®) as graft material. Plaque index, gingival index, pocket depth, clinical attachment levels were recorded clinically and bone fill, radiographically, at baseline, three months and six months. RESULTS AND CONCLUSION: Statistically significant reduction in pocket depth, plaque index, gingival index was seen after six months. There was significant bone fill seen from 3-6months with significant gain in clinical attachment levels.

Correlation of the interdental and the interradicular bone loss: A radiovisuographic analysis.

BACKGROUND: Presence of furcation involvement indicates advanced periodontitis, and a potentially less-favorable prognosis, for the affected tooth and its diagnosis has always been an enigma. The present study was carried out to measure and correlate the interdental and interradicular bone loss in patients suffering from periodontitis using radiovisuography (RVG) for the purpose of early furcation diagnosis. MATERIALS AND METHODS: A total of 50 patients suffering from chronic generalized periodontitis and with furcation involvement in mandibular molars were selected. Under standardized conditions, RVGs were taken and the morphologic measurements defining the furcation areas were recorded and analyzed. RESULT: Interradicular bone loss of about 0.8 mm or more, was observed in the study subjects only when the bone loss at the interdental area was minimal of 3.7 mm. The correlation between the interradicular and the interdental bone loss was statistically highly significant (T-test, P < 0.001). A stronger correlation was observed in subjects above 40 years of age as compared with the younger subjects. There was not much difference in the degree of correlation between the interradicular and the interdental bone loss when compared in the context of gender. CONCLUSION: The very first millimeter of interradicular bone loss was seen when the interdental bone loss was around 4 mm. Therefore, to detect the earliest lesions of furcations, the interdental bone loss can be kept as an approximate guide for the comprehensive diagnosis and management of such sites/patients. The current investigation paves the path for future longitudinal studies with larger samples to ascertain these findings.

Porphyromonas gingivalis antigenic determinants--potential targets for the vaccine development against periodontitis.

Periodontal disease, is the most prevalent inflammatory affliction characterized by the loss of supporting structures of the teeth. Although bacteria are identified as prime agents initiating the disease, but major part of tissue destruction is driven by the host immune response to infecting agent and is responsible for the clinical presentation of the disease. Porphyromonas gingivalis (P. gingivalis) has been identified as main microbial factor for causation and progression of periodontal disease. Three emerging concepts of periodontal disease viz wide prevalence, polymicrobial nature and their role in perpetuation of systemic diseases bear critical significance on the development of novel therapeutic approaches to eradicate or alleviate the disease burden. Therefore, development of preventive approaches such as periodontal vaccine appears as an exciting modality which can prove as a significant adjunct to current periodontal therapies. The new generation diagnostics including microbial genome sequencing and bioinformatics analysis are available now to detect and analyze the whole genomic and proteomic data regarding almost all human pathogens for exploring these as novel drug targets for vaccine development. The current review, aims to provide an update of wide-ranging virulence factors of P. gingivalis as potential antigenic targets for periodontal vaccine development.

Evaluation of efficacy of a bioresorbable membrane in the treatment of oral lichen planus.

BACKGROUND: Gingival involvement is commonly seen in lichen planus, a chronic mucocutaneous inflammatory condition of the stratified squamous epithelia. It is often painful and may undergo malignant transformation and thus warrants early diagnosis and prompt treatment. The aim of this study is to evaluate the use of a bioresorbable membrane (Polyglactin 910) in the management of erosive lichen planus of gingiva. MATERIALS AND METHODS: A split-mouth randomized controlled trial was carried out. Fifteen patients with identical bilateral lesions of lichen planus on gingiva were included in the study. Three parameters were selected for the clinical assessment of gingival lesions: Surface texture, color, and burning sensation. After complete oral prophylaxis, an excisional biopsy procedure was carried out for lesions on both sides, but on the experimental side, the biopsy procedure was combined with placement of the bioresorbable membrane. The statistical significance of intergroup differences in measurements was tested by using an independent sample t-test. A two-tailed P-value less than 0.05 was considered as statistically significant. RESULTS: Intragroup comparisons revealed a statistically significant difference between mean value of grades at 6, 12, and 24 weeks in both groups for the surface texture, color, and burning sensation of gingiva, respectively. For intergroup comparison of change in surface texture, color, and burning sensation of gingiva between group A and group B, differences were statistically nonsignificant. CONCLUSION: Surgical management of the lesion accomplished significant improvement of lesion with no significant additional clinical benefits with the application of bioresorbable membrane. Worsening of baseline scores was not observed in any case at the end of the study.

Embrasure morphology and central papilla recession.

BACKGROUND: The aim of this study was to ascertain the effects of vertical and horizontal distances between the maxillary central incisors on the presence of interproximal dental papilla and to assess the association between the embrasure morphology and central papilla recession. MATERIALS AND METHODS: The central papilla was visually assessed in 50 subjects using the standardized periapical radiographs of maxillary central incisors. The following vertical distances were measured; distance from the contact point to papilla tip, CP to proximal cementoenamel (pCEJ) junction, bone crest to CP (BC-CP) and BC-PT. The horizontal distance measured was interdental width (IDW) at pCEJ level. The measurements were recorded using a digital electronic caliper. RESULTS: Significant association between the embrasure morphology and central papilla recession was observed for all study groups. All the interdental variables were significantly related to the presence of interdental papillae, with BC-CP distance being the strongest determinant of central papilla presence. The percentage of interdental papilla presence was 100% when the BC-CP distance was ≤6 mm and IDW ranged between 0.5 and 1.5 mm. Central papilla recession was observed most frequently with wide-long and narrow-long embrasure morphology. CONCLUSION: In relation to maxillary central incisors, all the interdental variables have significant influences on the presence of interdental papillae, with distance from BC to CP being the strongest determinant of central papilla presence.

Epigenetics and periodontal disease: hope to tame the untameable.

Epigenetics means gene expression alterations which occur due to the biochemical changes of the nucleotides modifying structure of DNA rather than the changes in the genetic code itself as in case of mutations. The epigenome, consisting of chromatin and its modifications, acts as a link between the inherited genome and the changes imposed by the environment. Over the past decade, there has been mounting evidence suggestive of associations between epigenetic modifications and various human conditions such as aging, and most common human diseases viz. cancer, cardiovascular diseases, diabetes, rheumatoid arthritis, HIV etc and the clearest evidence as the central mechanism for common multifactorial diseases, has been identified with the factors involved in the inflammatory response. Periodontal disease, basically an immune-inflammatory affliction, being a multifactorial complex disease, owing to its high prevalence, chronicity and wide ranging systemic effects, essentially calls for a better comprehension of the underlying disease mechanisms, so as to develop and decipher the novel methodologies to combat this disease. The current paper aims to visualize periodontal disease from an epigenetic perspective, featuring the contemporary evidence supported literature and tends to explore the possibilities to find some explanations for perio-systemic health links, individualized and improvised diagnostic tools for earlier detection and ways to halt the disease and help regeneration and reconstruction of the lost periodontal attachment apparatus with the biology based approaches.

Proresolution mediators and receptors: novel drug targets for enhancing pharmacological armamentarium against periodontal inflammation.

Periodontal diseases are comprised of a group of inflammatory conditions that result in the destruction of the supporting structures of the dentition. Emphasis has traditionally been placed on the deleterious actions of lipid mediators, such as prostanoids and leukotrienes, in propagating the inflammatory response and enhancing tissue destruction. Recently, the emerging understanding of the molecular basis of inflammation has elucidated that return of tissue homeostasis, triggered as part of a normal inflammatory response i.e. resolution of inflammation is an active, agonist-mediated, well-orchestrated phenomenon. The naturally-occurring pro-resolution lipid mediators, lipoxins, resolvins, protectins, maresins etc. have been identified as a novel genus of potent and stereoselective players that counter-regulate excessive acute inflammation and stimulate molecular and cellular events that define resolution. In this Review, we provide an update and overview of newly identified mediators that play pivotal roles in resolution and focus on the emerging appreciation of the endogenous pathways and mediators that control timely resolution which can be exploited as novel drug targets to extend the pharamaceutical armamentarium to combat chronic inflammation, thus controlling periodontal inflammation and the associated systemic inflammatory effects on the body, in general.

Evaluation of the efficacy of a bioactive synthetic graft material in the treatment of intrabony periodontal defects.

BACKGROUND: Bioactive ceramic fillers are synthetic materials which have shown the potential to enhance bone formation. The purpose of this study was to evaluate the efficacy of a bioactive synthetic graft material in the treatment of intrabony periodontal defects. MATERIALS AND METHODS: Fourteen intrabony defects in twelve systemically healthy subjects having moderate to severe chronic periodontitis were evaluated after bone grafting with bioactive ceramic filler for a period of 6 months. Clinical and radiographic evaluations were made at baseline, at 3 and 6 months following surgery. RESULTS: Mean radiographic defect fill of 64.76% (2.49±0.5 mm) was observed in 6 months, which was statistically significant. A statistically significant relative attachment level gain of 2.71±1.13 mm and probing pocket depth reduction of 4.21±1.18 mm was recorded at the end of the study. A significant decrease in mobility and gingival index was observed. CONCLUSIONS: Bioactive glass is an efficacious treatment option for the reconstruction of intrabony periodontal defects as it led to statistically significant improvements in the clinical and radiographic parameters.

Interest and satisfaction of dentists in practicing periodontics: A survey based on treatment of gingival recession.

BACKGROUND: Gingival recession is a common occurrence and patients often report to dental clinic with associated problems such as root surface hypersensitivity, esthetic concerns, cervical root abrasions, and root caries that make it a concern for patients. Based upon the fact that gingival recession is an enigma for clinicians because of multitude of etiological factors and plethora of treatment modalities present for its treatment, a survey was conducted to assess knowledge as well as opinion about most common etiology, classification, and preferred treatment of gingival recession and to evaluate the interest and satisfaction of dentists in practicing periodontics. MATERIALS AND METHODS: Study design consisted of a cross-sectional online survey, conducted among dentists practicing in state of Punjab, India, in the month of April 2011. A structured online questionnaire consisting of 17 questions evaluating the interest of dentists in periodontics based on knowledge about gingival recession (most of them giving the possibility of multiple choices of answers) was sent to about 300 dentists. Pearson Chi-Square and Mann-Whitney U tests were used for statistical analysis of data collected. P ≤ 0.05 was considered as statistically significant and P ≤ 0.01 considered as highly significant. RESULTS: A greater proportion of periodontists had better knowledge about etiology (P = 0.07), classification (P = 0.000), and treatment of gingival recession (P = 0.000). A greater number of periodontists opted for the surgical modalities to correct the defects produced by gingival recession as compared to non-periodontists and had better interest (P = 0.000) and satisfaction (P = 0.000) in practicing periodontics. CONCLUSION: The results elucidated that periodontists had better interest and satisfaction in practicing periodontics, and were more inclined towards surgical correction of gingival recession as compared to non-periodontists.

Effect of scaling and root planing on erythrocyte count, hemoglobin and hematocrit in patients with chronic periodontal disease.

PURPOSE: Anemia of chronic disease, a cytokine-mediated anemia, is a frequent complication of many chronic inflammatory conditions. The present clinical trial was aimed to evaluate the effect of chronic periodontal disease on erythrocyte count, hemoglobin and hematocrit and the changes produced in these parameters after the provision of periodontal therapy. METHODS: 40 systemically healthy non-smoker male subjects in the age group of 25 to 50 years suffering with chronic periodontal disease were selected and categorized into 2 groups. Group A was categorized as chronic generalized gingivitis, and Group B was categorized as chronic generalized periodontitis on the basis of clinical findings. The clinical parameters Gingival Index (GI), Probing Pock et Depth (PPD) and Relative Attachment Level (RAL) and laboratory blood investigations viz erythrocyte count (EC), hemoglobin (Hb), hematocrit (HCT) and red cell indices (MCV, MCH, MCHC) were recorded at baseline. Complete oral prophylaxis was performed for all patients. Patients were recalled after 3 weeks and 3 months. The clinical and hematological parameters were re-evaluated to analyze the changes after provision of phase I therapy. RESULTS: The mean values of EC, Hb and HCT were significantly lower in Group B in comparison to Group A, and showed a significantly greater increase at 3 months of observation. However, the values of MCV, MCH and MCHC showed a non significant change during the same observation period in both the groups. CONCLUSION: Lower values of EC, Hb and HCT in Group B showed that mild anemia is associated with chronic generalized periodontitis, which tends to improve after provision of periodontal therapy. Minimal changes in MCV, MCH and MCHC indicated that the lower values are not due to any vitamin and mineral deficiencies, but secondary to the chronic inflammatory changes associated with chronic periodontal disease.

Systemic antibiotic therapy in periodontics.

Systemic antibiotics in conjunction with scaling and root planing (SRP), can offer an additional benefit over SRP alone in the treatment of periodontitis, in terms of clinical attachment loss (CAL) and pocket depth change, and reduced risk of additional CAL loss. However, antibiotics are not innocuous drugs. Their use should be justified on the basis of a clearly established need and should not be substituted for adequate local treatment. The aim of this review is to discuss the rationale, proper selection, dosage and duration for antibiotic therapy so as to optimize the usefulness of drug therapy.

Bone allografts: a review of safety and efficacy.

Although bone allografts are being widely used in dentistry, many of clinicians appear to be unfamiliar with their preparation and processing as well as their use as safe and effective graft materials. The major concerns associated with these materials are antigenicity and risk of disease transmission from donor to recipient. To minimize this risk, the production of an allograft worthy of distribution and implantation requires strict attention to detail through a comprehensive process. With an increasing clinical requirement for bone grafting procedures, there is a commensurate increase in patients' demands for assurance that bank bone will not be infected with pathogens. To ensure the patients, dental surgeons should be able to cite factual information and recommendations by responsible organizations regarding safety of allografts. Knowledge of human bone allograft procurement, processing, and tracking may allow dentists to better educate patients and address concerns about this valuable treatment option. The purpose of this review is to furnish and update the current knowledge on processing, safety, and efficacy of allograft materials.

Effect of zoledronic Acid on bone mineral density in men with prostate cancer receiving gonadotropin-releasing hormone analog.

Background. Loss of bone density with androgen deprivation therapy for prostate cancer is well recognized. We assessed the effects of quarterly infusion of zoledronic acid on bone mineral density (BMD) and markers of bone turnover over a one-year period in men receiving gonadotropin-releasing hormone analog (GnRH-a) for prostate cancer. Methods. 41 subjects were randomly assigned to treatment with zoledronic acid (4 mg) IV infusion or placebo every 3 months. The primary endpoint was the change in the lumbar spine BMD after 12 months of treatment. Results. The change in vertebral BMD in the zoledronic acid group (+7.93 ± 1.4%) was significantly (P < .05) greater than the change in the placebo group (+0.82 ± 1.7%) as was the change in left femoral neck BMD (+5.05 ± 1.4% for the zoledronic acid group versus -0.48 ± 1.4% for the placebo group). The decrease in biochemical markers of bone turnover was significantly (P < .05) greater in the zoledronic acid group compared to the placebo group. Conclusion. Quarterly infusion of zoledronic acid for 1 year improved vertebral and left femoral neck BMD with a decrease in bone turnover markers in men on GnRH-a treatment. Zoledronic acid treatment appears to be promising in men with low BMD receiving GnRH-a treatment.