25 July 2023

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Implantology in patients with osteoporosis

Lara Figini

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With aging patients, conditions and systemic pathologies such as osteoporosis, the longevity and success of implant treatment can be compromised.

Osteoporosis is a generalized skeletal disorder that causes a reduction in bone density and microarchitectural degradation, with an increase in the trabecular spaces in the bone, resulting in increased fragility and the possibility of fractures.

This systemic condition is estimated to affect more than 300 million people worldwide, mainly women >50 years of age.

As an osseointegrated structure, the dental implant has intimate contact with the bone and a reduction in bone quality caused by osteoporosis could affect the osseointegration and consequently the survival rate and maintenance of the bone around the dental implant.

Materials and methods

In a systematic review with meta-analysis published in Clinical Oral Investigation in June 2023, the authors compared the survival rate of dental implants and marginal bone loss between patients with osteoporosis and those without osteoporosis.

This systematic review was registered in PROSPERO (CRD42022356377) and was performed using five databases: Medline/PubMed, Web of Science, Scopus, Embase and ProQuest for articles published up to July 2022. Additional searches were performed on ClinicalTrials.gov and in the reference lists of included studies.

Eligibility criteria included observational studies with a direct comparison of patients with and without osteoporosis, with a minimum follow-up of 1 year and 10 implants placed in each group, considering data analysis based on implant level, without limitations period or language of publication.

Meta-analysis was performed using the RevMan 5.4 program. Risk of bias analysis of included studies was performed using the Newcastle-Ottawa Scale (NOS).

Results

Twelve studies met the eligibility criteria, involving a total of 1132 patients with a mean age ranging from 54 to 76.6 years. Most of the patients included in the review were women (73.6%). A total of 3505 implants were evaluated, 983 in patients with osteoporosis and 2522 in patients without osteoporosis.

The meta-analysis indicated no difference in implant survival rates between patients with and without osteoporosis (OR, 1.78; 95% confidence interval [CI], 0.86-3.70; P = 0.12). However, significant bone loss was observed around dental implants placed in patients with osteoporosis (SMD, 0.71 mm; 95% CI, 0.06-0.87 mm).

A minimal risk of bias was found in the included studies. However, the certainty of the evidence was rated as exceptionally low and low for implant survival rates and bone loss, respectively.

Conclusions

From the data of this review, it can be concluded that dental implants are a predictable treatment option for the rehabilitation of patients with osteoporosis.

However, professional clinical care is required to ensure that peri-implant bone stability is maintained, as these patients may be prone to increased bone loss.

For more information: "Do dental implants placed in patients with osteoporosis have higher risks of failure and marginal bone loss compared to those in healthy patients? A systematic review with meta analysis."