Does Osteoporosis Increase Implant Failure in Patients?

Multiple recent research studies indicate that dental implant failure rates were not higher in osteoporosis patients compared to patients without osteoporosis. The implant survival rate in bone tissue with osteoporosis was similar to that of the control group at the implant level (P = 0.11) and the patient level (P = 0.94)

Research information was sourced from PubMed, the Cochrane Library, Web of Science, and SciELO databases—updated till September 2016—to study the link between osteoporosis and implant failure. Other studies were also referenced—limiting the search in the English language.

Selection of Study

Only studies with at least five patients were examined, and clinical case studies were not considered. Clinical monitoring studies, including controlled and randomized clinical trials, and retrospective and prospective studies with a minimum of six months of follow-up were considered for the reviews.

According to guidelines, animal and in-vitro studies, as well as studies with insufficient data and non-controlled clinical cases, were omitted.

Results of the study

The series of studies carried out to find a link between osteoporosis and dental implant survival involved 8859 patients and 29,798 implants. The average age of patients was 63.03 years, and the review included 15 observational studies. Follow-up period range was within 0.75 to 22 years, and the mean average was 5.85 years. The studies included a minimum implant size of 3.3 mm in diameter and 7 mm in length.

The relative risk (RR) of implant failure and the mean marginal bone loss were analyzed within a 95% confidence interval (CI). No visible outcome showing a difference in patient’s implant survival rate (with or without osteoporosis) was seen after the meta-analysis. No difference was seen at the patient level (RR 0.98, 95% CI 0.50–1.89; P = 0.94) or the implant level (RR 1.39, 95% CI 0.93–2.08; P = 0.11).

However, substantial variance in peripheral bone loss was seen after meta-analysis for the secondary outcome. Both patients with and without osteoporosis (0.18 mm, 95% CI 0.05–0.30, P = 0.005) were part of the study. Data heterogeneity was small, and an increase in peri-implant bone loss was detected in the osteoporosis group.

 Mining and Synthesis of Data

The bias scale from the Australian National Health and Medical Research Council (NHMRC) was used to analyze the quality of the studies, and four reviewers performed the screening and research. Disagreements among the reviewers were primarily resolved by discussion.

Data mined for the studies included the following information:

• Author name
• Year of publication
• Country of study
• Number of patients
• Implants:
• Number of implants
• Number of sites
• Type of implant
• Length and diameter
• Oral rehabilitation installation time
• The peri-implant bone loss rate
• The implant survival rate in each instance
• Follow-up time of each study
• Study type
• Drugs administered for the treatment of osteoporosis
• For binary outcomes (implant failure): an estimate of the intervention effect was expressed in the form of a relative risk (RR) with the confidence interval (CI) of 95%
• For continuous outcomes (marginal bone loss), average and standard deviation (SD) were used to calculate the standardized mean difference with a 95% CI
• Heterogeneity was achieved during the studies using a statistical test while exploring publication bias