Antiresorptive Therapy to Reduce Fracture Risk and Effects on Dental Implant Outcomes in Patients With Osteoporosis: A Systematic Review and Osteonecrosis of the Jaw Taskforce Consensus Statement
Dalal S. Ali, Aliya Khan, Archibald Morrison, Sotirios Tetradis, Reza Mirza, Mohamed El Rabbany, Bo Abrahamsen, Tara Aghaloo, Hatim Al-Alwani, Rana Aldabagh, Athanasios D. Anastasilakis, Mohit Bhandari, Jean-Jacques Body, Maria Luisa Brandi, Romina Brignardello-Petersen, Jacques P. Brown, Angela M. Cheung, Juliet Compston, Cyrus Cooper, Adolfo Díez‐Pérez, Serge Ferrari, Gordon Guyatt, David A. Hanley, Nicholas C. Harvey, Robert G. Josse, David L. Kendler, Sarah Khan, Sandra Kim, Bente Langdahl, Christos Magopoulos, Basel Masri, Sarah Morgan, Suzanne N. Morin, Nicola Napoli, Barbara Obermayer‐Pietsch, Andrea Palermo, Jessica Pepe, Edmund Peters, Dominique D. Pierroz, René Rizzoli, Deborah Saunders, Clark M. Stanford, Riad A. Sulimani, Akira Taguchi, Sakae Tanaka, Nelson B. Watts, Joile Zamudio, M. Carola Zillikens, Salvatore L. Ruggiero
Abstract
OBJECTIVE: Placement of a dental implant in a patient on antiresorptive therapy has been hypothesized to increase the risk of medication-related osteonecrosis of the jaw (MRONJ) and/or impact implant survival. In patients with osteoporosis, the risk of MRONJ with antiresorptive therapy is only marginally higher than observed in the general population. METHODS: The International ONJ Taskforce conducted a systematic review of the literature and evaluated the outcomes of implant placement in individuals with osteoporosis receiving antiresorptive therapy. RESULTS: The data were reviewed by the International Taskforce, and consensus was achieved on the following GRADEd recommendation. In patients with osteoporosis on antiresorptive therapy, the Taskforce suggests that antiresorptive therapy does not need to be stopped prior to proceeding with dental implant (weak recommendation, very low-quality evidence). Long-term bisphosphonate use maybe associated with a small increase in the risk of MRONJ (3 cases per 1000 patients; adjusted hazard ratio: 4.09, 95% CI: 2.75-6.09, P < .001, moderate certainty). CONCLUSION: Current evidence does not suggest an association between antiresorptive therapy in patients with osteoporosis and dental implant failure. Implants may be safely placed in the presence of concomitant use of bisphosphonates or denosumab in patients with osteoporosis with no evidence of an increased risk of implant failure/compromise.