Vol. 8, No. 2 August 1995 Insights Newsletter Continues:

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Osteoporosis: A Risk Factor for Osseointegration of Dental Implant

Dao TT, Anderson JD, Zarb GA

The success of osseointegration depends in part on the state of the bone, the host site, and its healing capacity. Concerns have therefore been raised about the treatment of osteoporotic patients with osseointegrated dental implants. Osteoporosis is a condition believed to be associated with a decrease in bone quality and bone quantity. Whether osteoporosis effects bone quality, bone quantity, or both, remains a matter of controversy. Thus a diagnosis of osteoporosis made solely on the basis of bone mass remains empirical and arbitrary.

However, the orthopedic literature indicates that osteoporotic fractures heal readily, and the level of bone mass and estimates of the parameters associated with bone remodeling present considerable overlap between patients with osteoporosis and control subjects. The concern that osteoporosis effects the mandible or the maxilla in the same manner as other parts of the skeleton that serve as diagnostic markers for the disease; and the impaired bone metabolism in osteoporotic bone may reduce the healing capacity around implants.

It appears that osteoporosis diagnosed at one particular site of the skeleton is not necessarily seen at another distant site. This is not surprising because bones in different locations are subjected to different biomechanical stress is known to influence remodeling of bone tissue.

The literature clearly indicates that osteoporosis increases with age and is more prevalent in women than in men. The prevalence of osteoporosis in asymptomatic women has be reported to be as high as 25% for those 45 to 54 years and 39.2% for the range 50 to 54 years. If there were a direct correlation between osteoporosis and predictability for osseointegration, we would expect to find the rate of implant loss caused by failure of osseointegration to increase corresponding to age and gender.

The results of this study indicate that the rate of implant failure is not related with age and sex, thus subjects at risk for osteoporosis are not at risk for implant failure. A review of the literature and the results of a series of patients treated does not provide a compelling theoretic or practical basis to expect osteoporosis to be a risk factor for osseointegrated dental implants.

Therefore, denying implant treatment to a patient whose diagnosis of osteoporosis is based on a decrease in bone mass, or on the presence of a traumatic fracture in a site other than the jaw itself cannot be supported at this time. It is important that treatment planning for dental implant therapy be based on a local assessment of the potential surgical site.

Int J & Maxillof Impl 1993;8:137-144.