Osteoporosis’ effects on dental implants osseointegration and survival rate: a systematic review of clinical studies

Objectives: The goal of this systematic review was to critically appraise the existing evidence evaluating osteoporosis’ effects on dental implant osseointegration and survival rate.
Data source: A search was conducted in two databases, PubMed/MEDLINE and Scopus, until October 2024, using the keywords “osteoporosis,” “osteopenia,” “osseointegration,” and “dental implants”. The inclusion criteria were clinical studies that evaluated the implant placement, complications, and osseointegration results in patients with osteoporosis; literature reviews and clinical studies addressing the outcome were considered; and articles written in English and published since 2000. Descriptive data analysis included author, year of publication, study design, number of patients, osteoporosis assessment, follow-up, and main findings. JBI quality assessment was performed. Overall, 24 articles were included with a total of 2,102 patients; 5,954 dental implants were considered and evaluated. Most studies evaluated bone density for osteoporosis by dual-energy x-ray technology. The follow-up ranged from 1 month to 25 years. Four studies evaluated implants with over 10 years of follow-up. All studies’ survival rate was higher than 90%, even for osteoporotic patients. Most studies indicated no differences between osteoporotic and healthy patients regarding marginal bone loss, bone-to-implant contact, cytokine levels, and mineral bone density. A prospective cohort study found a small marginal bone loss (−0.34 mm) in osteoporotic women, but there was insufficient evidence to prove any causal relationship between marginal bone loss and osteoporosis. Another study showed no clinical differences between implants placed in osteoporotic and healthy individuals. In contrast, other studies showed lower stability scores for implants placed in osteoporotic sites and a higher risk of failure for implant placement. Osteoporosis status was not a risk factor for dental implant failure, which was also confirmed by histologic studies. Three studies had a medium risk of bias, and 21 a low risk.
Conclusion: Osteoporosis is not a contraindication for dental implant placement. Osseointegration in patients with osteoporosis is feasible; however, planning must be cautious and personalized for the placement of dental implants.