Osteoporotic patients who take oral bisphosphonates have a higher chance of developing osteonecrosis of the jaw if they receive dental implants.
Bisphosphonate treatment was first identified by Marx in 2003 as a possible contributor to osteonecrosis of the jaw, a serious dental-medical complication that is seen among individuals undergoing invasive dental procedures such as extractions and implant placement. Bisphosphonate-associated osteonecrosis of the jaw (BONJ) is defined as bone exposed for more than 8 weeks in the maxillofacial region with a negative history for radiation therapy.
A retrospective review of patient electronic health records (EHRs) at the University of Pittsburgh School of Dental Medicine identified 211 women who received 592 dental implants between January 2008 and August 2010. Each woman's EHR was searched for notation in the clinical record of evidence of osteonecrosis of the jaw. Only women taking oral bisphosphonates were included.
Among the total 211 women, 120 exceeded age 50 and had received 347 implants. Twenty-two reported taking oral bisphosphonates as treatment for osteoporosis, one as treatment for osteoarthritis. Five additional women reported taking alternative medications instead of bisphosphonates as treatment for diagnosed osteoporosis. Seventy-five implants were placed in women self-reporting a history of oral bisphosphonates; seven implants were placed in osteoporotic women who did not self-report oral bisphosphonate treatment. There was no evidence of osteonecrosis of the jaw in the follow-up medical record of any patient. Only one implant did not osseointegrate and was replaced within 1 year. This 98.7% success rate is consistent with standard implant success rates.
Oral bisphosphonate therapy did not appear to significantly affect implant success. Implant placement in osteoporotic women taking oral bisphosphonates in treatment for osteoporosis did not result in reported clinical evidence of osteonecrosis of the jaw. Nevertheless, because of the increasing number of osteoporotic patients being treated with bisphosphonates, a better understanding of the risks of implant placement in such patients would benefit both the clinician and patient.