Page 15 - GP fall 2023

Are Dental Implants Advisable for Patients
with Osteoporosis Taking Oral Bisphosphonates?

Authors: Diana Alomaja, Tara Byrd, DDS, Geri Robin, DMD, FAGD, and Analia Veitz-Keenan, DDS, FAGD

Background:
According to the Department of Health and According to the American Association of This review aims to focus on the impact of
Human Services, osteoporosis is a progres- Oral and Maxillofacial Surgeons, an esti- oral administration of the alkyl-amino bis-
sive metabolic bone disease characterized mated 30 million bisphosphonate prescrip- phosphonate group because the patient in
by low bone density and deterioration of tions are written yearly in the United States our case presented for dental care was pre-
bone architecture that increases the risk of and more than 190 million are written scribed Alendronate (Fosamax®; oral, 70
fractures. This disease is known to cause worldwide. 6 mg), which acts as an inhibitor of farnesyl
a deterioration of the trabecular network, pyrophosphate synthase (FPPS), the en-
which may be related to changes at the tis- The mechanism of action of bisphospho- zyme that plays a role in osteoclast cell
sue scale. Contrastingly, a study conduct- nates inhibits bone resorption via actions processes, such as bone resorption. Alen-
ed by Frank et al. suggests that the distinct on osteoclasts or osteoclast precursors; it dronate is the most commonly prescribed
changes in trabecular bone quality caused decreases the rate of bone resorption, lead- drug for treating postmenopausal osteopo-
by osteoporosis and aging could not be ing to an indirect increase in bone mineral rosis and is associated with increased bone
linked to suspected relevant changes in ma- density. There are two routes of bisphos- mineral density and fracture risk reduc-
terial properties or tissue mineralization. 1 phonate administration: oral and intrave- tion. 16.
nous (IV). Oral absorption is poor, but the
Bone is made of 35% osteoid, and its hard- skeleton rapidly absorbs the drug and ex- Since, for the current evidence, a risk of
ness is obtained from 65% inorganic hy- cretes it unchanged by the kidney. 7 adverse events or side effects may still
droxyapatite. The adverse effects of osteo- be present, the purpose of this review is
porosis on healthy bone lead to osteoclasts Oral manifestations of osteoporosis include to compile the evidence available on the
breaking down bone faster than the osteo- systemic bone loss, which serves as a pre- same topic to assist practitioners in deci-
blasts can rebuild, lowering the bone mass dictor of increased risk of edentulism in sion-making, particularly for the patient
over time and increasing fragility (i.e., postmenopausal women. For many years who is taking oral bisphosphonates.
pathologic fracture). Risk factors of oste- the adverse oral effects of bisphosphonates
oporosis include early menopause, eating for which dentists were advised to include Methodology- Search
disorders, history of missed menses, family osteonecrosis, which refers to necrotic For clinical practice, well-constructed sys-
history, celiac disease, irritable bowel dis- bone, also called medication-related osteo- tematic reviews and their unbiased results
ease, and smoking. 2 necrosis of the jaw (MRONJ). Factors that are what clinicians are expected to read and
increase the risk of bisphosphonate-related apply into practice. However, when mul-
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According to Salari et al., as of 2021, the osteonecrosis of the jaw include patients tiple systematic reviews exist on the same
prevalence of osteoporosis in women older than 65 years old, periodontitis, using topic, it is difficult for practitioners to make
worldwide is 23.1%. It is important to note bisphosphonates for more than two years, decisions and understand their differences
that osteoporosis can occur in both sexes. smoking, diabetes, and denture use. 8 and significance for practice. For the pur-
However, most research on osteoporosis pose of this dilemma, we searched for the
has focused on women because women are A common database, Lexicomp, used by best available evidence on the current topic
more likely than men to develop osteoporo- dentists to search for medications, side ef- in different databases.
sis and subsequent fractures. 3 fects, and interactions, states that oral bis-
phosphonates’ impact on dental treatment The databases searched included: Pubmed
The Endocrine Society recommends bis- is generally associated with jaw osteone- and Epistemonikos - The search retrieved
phosphonates, excluding ibandronate, as a crosis. 9-11 However, it is known that most 16 systematic reviews from Pubmed and 35
first-line option for the prevention and/or reported cases of MRONJ in patients tak- articles from Epistemonikos. After remov-
treatment of osteoporosis in postmenopaus- ing bisphosphonates have been in cancer ing the duplicates, we selected the most
4
al women. Bisphosphonates are analogs of patients treated with IV bisphosphonates. relevant articles that matched our criteria.
natural inorganic pyrophosphates required There have been reported cases of post-
to treat certain skeletal disorders, such as menopausal women taking oral bisphos-
osteoporosis. The primary pharmacolog- phonates developing MRONJ. However, Results:
ical action of these drugs is to suppress the risk is low, with a prevalence of 0.1%. 12 Eleven systematic reviews were selected
bone resorption by inhibiting osteoclast from the search, and meaningful outcomes
function. Bisphosphonates are categorized What is known is that oral or intravenous were extracted.
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into three groups: 1) non-nitrogenous bis- bisphosphonate use history is not an ab- A tool to assess each review’s validity
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phosphonates, 2) alkyl-amino-bisphospho- solute contraindication for dental implant and relevance was used for appraisal.
nates, and 3) heterocyclic nitrogen bisphos- placement, and dental implants can osse- (Table 1).
phonates. ointegrate successfully in this patient pop- continued on next page
ulation. 13-15
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