On the Association between Dental Implants, Osteoporosis and Bone Modulating Therapy

Background: Osteoporosis affects bone metabolism and may result in fragility fractures. Medications include bone modulating therapy (BMT), which come with the risk of osteonecrosis of the jaws (ONJ). The literature is contradictory about the impact of osteoporosis and/or BMT on dental implant success and the incidence of ONJ. Purpose: The aim of the present study was to assess the effect of osteoporosis and BMT on early implant failure (EIF) and ONJ incidence (primary outcome parameters) following dental implant placement. Materials and Methods: Retrospective, cohort study based on dental records. Implant-supported prostheses (ISP) were delivered by experienced oral and maxillofacial surgeons and prosthodontists. Inclusion criteria: diagnosis of osteoporosis, delivery of ISP, consecutive individuals, and available data. Confounding variables included-age, gender, smoking status, BMT, bone grafting, and implant length/diameter. Results: There were a total of 72 osteoporosis patients, 46 using and 26 not using BMT. There were a total of 279 inserted implants, 154 in those using and 124 in those not using BMT. Univariate analysis of factors that may affect EIF showed no statistically significant differences between non-osteoporotic, osteoporotic using BMT, and osteoporotic patients not using BMT regarding EIF and ONJ incidence following dental implant delivery. Multivariate model using logistic regression demonstrated one factor associated with increased risk for EIF-bone augmentation. No cases of ONJ were reported up to one year post ISP delivery in any group. Conclusions: Within the limitations of the present study, it can be concluded that installing dental implants in osteoporotic patients, treated or not with BMT, is a safe procedure with EIF comparable to non-osteoporotic patients. The short-term risk for ONJ following dental implant insertion in osteoporotic (even when using BMT) patients is negligible.