23 October 2019

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Can osteoporosis affect implantation success?

Lara Figini

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It is estimated that 1 in 2 women and 1 in 5 men over the age of 50 may develop a fracture due to osteoporosis. 
Osteoporosis is defined as a skeletal disease characterized by low bone tissue density. The consistency and bone density result from a finely regulated balancebetween bone resorption and new bone formation, determined by the degrade of thebone matrix, obtained by osteoclasts, and by reconstruction of the same by osteoblasts. An alteration of this balance leads to a deterioration of microarchitectureof trabecular bone, increasing bone fragility and cortical bone porosity. Systemic osteoporosis can also affect the quantity and quality of bone in the maxillofacial district, particularly in edentulous regions. Based on preclinical animal laboratory studies, it has been hypothesized that patients with osteoporosis / osteopenia may be more at risk of developing inadequate osseointegration and a reduction in long-term implant survival. However, the data currently available in the literature remain inconclusive; moreover, most of these are short term and are unable to show an actual correlation between osteoporosis and implant failure. 

Materials and Methods
In a multicenter clinical study, published in the Journal of Dental Research in January 2019, attempts were made to provide long-term information on the clinical performance of the implants inpatients with diagnosed systemic primary osteoporosis / osteopenia.In this study, post-menopausal women who needed implants were considered. To these women bone mineral density measurements were performed in the hip and vertebral column, using two X-ray absorptiometry scans. Based on the T scores, they were then divided into 2 groups:- group O (group with osteoporosis) with a T-score ≤-2- group C (control group) with a T-score of ≥-1.The implants were placed in two phases and loaded from 4 to 8 weeks after the implant insertion intervention. Six months after loading and subsequently each year the clinical and radiographic parameters were evaluated.A total of 148 implants were placed in 48 patients (average age: 67). Sixty-three implants were placed in 20 patients (group O) and 85 implants in 28 patients (group C). After 5 years, 117 implants (38 in group O and 79 in group C) were evaluated in 37 patients. 

Results
The cumulative survival rate was 96.5%. The overall marginal bone alterations, after 5 y of load, were found to be -0.09 ± 0.78 mm(group O: -0.15 ± 0.50 mm, group C: -0.06 ± 0.89 mm) at the level of the implant and -0.09 ± 0.54 mm (group O: -0.18 ± 0.43 mm; C: 0.06 ± 0.58 mm) at the general oral bone level of the patients (P> 0.05). 

Conclusions 
From the data emerging from this study, which however need to be confirmed in other similar clinical studies, it can be concluded that oral implant therapy in osteoporotic patients is a reliable therapeutic option with osteointegration rates, implant survival and marginal changes at bone level , after 5 y of functional load, comparable to those obtained in healthy patients.

For additional informations: A Prospective, Controlled, Multicenter Study to Evaluate the Clinical Outcome of Implant Treatment in Women with Osteoporosis/Osteopenia: 5-Year Results  

Italian version: http://www.odontoiatria33.it/implantologia/17348/l-osteoporosi-puo-condizionare-il-successo-implantare.html