The effect of antiresorptive drugs on implant therapy: Systematic review and meta‐analysis

Abstract

Objectives: A considerable portion of the adult population has received and/or is receiving treatment with antiresorptive drugs (ARDs). It is thus relevant to assess possible side effects of ARD intake in connection to various aspects of implant therapy. The aim of this study was to answer the focused question "In patients with systemic intake of ARDs, what is the outcome and complication rate of implant therapy including associated bone grafting procedures comparing to patients without systemic intake of ARDs?" Materials and Methods:Original studies fulfilled predefined inclusion criteria (e.g., case series, cohort studies, case-control studies, and controlled and/or randomized controlled clinical trials; retro-or prospective design; and ≥10 patients with systemic intake of ARDs). Various patient-, medication-, and intervention-related parameters [i.e., implant loss, grafting procedure complication/failure, peri-implant marginal bone levels/loss, medication-related osteonecrosis of the jaws (MRONJ), and periimplantitis] were extracted, and meta-analyses and quality assessment were performed. Results:Twenty-four studies with bisphosphonate (BP) intake (mainly low dose for osteoporosis treatment) and seven studies on hormone replacement therapy (HRT), including ≥10 patients, and controls not taking the medication were identified.Furthermore, seven studies on MRONJ associated with implants were included.Meta-analyses based on four studies reporting on patient level and eight studies reporting on implant level showed no significant differences in terms of implant loss between patients on BPs (mainly low dose for osteoporosis treatment) and controls.Furthermore, low-dose BP intake did not compromise peri-implant marginal bone levels. Based on two studies, no negative effect of HRT was observed on the implant level, while HRT appeared to exert a marginally significant negative effect regarding implant survival on the patient level and regarding peri-implant marginal bone levels.Based on six studies reporting single-patient data, MRONJ in patients on BP for osteoporosis appeared in 70% of the cases >36 months after start of drug intake, while in patients with cancer, MRONJ appeared in 64% of the cases ≤36 months after first BP intake.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. | 55STAVROPOULOS eT AL. | 57 STAVROPOULOS eT AL.Random-effects meta-analyses, separately for each ARD type, were implemented to calculate from the included cohort and casecontrol studies pooled estimates at the patient and/or implant level.All statistical analyses were performed using Stata (StataCorp LLC, USA).

Sustained Release of Melatonin from GelMA Liposomes Reduced Osteoblast Apoptosis and Improved Implant Osseointegration in Osteoporosis

“…At present, the use of screws with an enlarged diameter, traditional antiosteoporosis drugs, and bone cement injection are the main treatment methods in clinic [11][12][13]. Among these methods, systemic antiosteoporosis drugs, such as bisphosphonates, denosumab, raloxifene, and teriparatide, are used to strengthen the strength of osteoporotic bone internal fixation [14,15].…”

Fogászati implantáció biszfoszfonát terápiában részesülő betegeknél

“…Az egyikben hozzávetőlegesen 16.000 páciens közül 5 esetben (0,031%) alakult ki implantátummal kapcsolatba hozható állcsontnekrózis [15]. A másik közleményben 589 páciens között egy esetben észlelték az implantációt követő MRONJ kialakulását (0,16%) [44].…”

Osteonecrose mandibular associada ao uso de medicamentos: relato de caso

“…pirofosfato (PPi), uma substância com uma ligação POP química que é bem conhecida por sua atividade biológica em interferir com a dissolução e precipitação do fosfato de cálcio, o principal componente do osso mineralizado. São classificados em dois grupos: bisfosfonatos não contendo nitrogênio (por exemplo, etidronato e clodronato) e bisfosfonatos contendo nitrogênio (por exemplo, pamidronato, alendronato, risedronato, ibandronato e zoledronato) 3 .…”

“…A via de administração influencia a captação esquelética dos BPs e, portanto, indiretamente a dose; especificamente, administrados por via intravenosa (IV) (pamidronato e zoledronato) estão ligados em quantidades muito grandes e são usados principalmente no tratamento de neoplasias malignas e doença óssea de Paget, e apenas em extensão limitada para o tratamento da osteoporose, enquanto BPs administrados por via oral (por exemplo, alendronato e risedronato) são ligados em quantidades significativamente menores (<1% dos BPs administrados por via oral é absorvido pelo trato gastrointestinal) e são predominantemente usados no tratamento da osteoporose e raramente, em alguns tipos de câncer, para a prevenção de osteoporose secundária 3 .…”