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 A Khan; Archibald Morrison; Sotirios Tetradis; Reza D Mirza; Mohamed El Rabbany; Bo Abrahamsen; Tara L Aghaloo; Hatim Al-Alwani; Rana Al-Dabagh; 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 Diez-Perez; Serge L Ferrari; Gordon Guyatt; David Hanley; Nicholas C Harvey; Robert G Josse; David L Kendler; Sarah Khan; Sandra Kim; Bente L Langdahl; Christos Magopoulos; Basel K Masri; Sarah L Morgan; Suzanne N Morin; Nicola Napoli; Barbara Obermayer-Pietsch; Andrea Palermo; Jessica Pepe; Edmund Peters; Dominique D Pierroz; Rene Rizzoli; Deborah P Saunders; Clark M Stanford; Riad Sulimani; Akira Taguchi; Sakae Tanaka; Nelson B Watts; Joile Zamudio; M Carola Zillikens; Salvatore L Ruggiero

doi:10.1016/j.eprac.2025.02.016

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 A Khan^*, Archibald Morrison, Sotirios Tetradis, Reza D Mirza, Mohamed El Rabbany, Bo Abrahamsen, Tara L Aghaloo, Hatim Al-Alwani, Rana Al-Dabagh, 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 Diez-PerezSerge L Ferrari, Gordon Guyatt, David Hanley, Nicholas C Harvey, Robert G Josse, David L Kendler, Sarah Khan, Sandra Kim, Bente L Langdahl, Christos Magopoulos, Basel K Masri, Sarah L Morgan, Suzanne N Morin, Nicola Napoli, Barbara Obermayer-Pietsch, Andrea Palermo, Jessica Pepe, Edmund Peters, Dominique D Pierroz, Rene Rizzoli, Deborah P Saunders, Clark M Stanford, Riad Sulimani, Akira Taguchi, Sakae Tanaka, Nelson B Watts, Joile Zamudio, M Carola Zillikens, Salvatore L Ruggiero

^*Corresponding author af dette arbejde

Medicin 1

Publikation: Bidrag til tidsskrift › Review › Forskning › peer review

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.

Originalsprog	Engelsk
Sider (fra-til)	686-698
Antal sider	13
Tidsskrift	Endocrine Practice
Vol/bind	31
Udgave nummer	5
DOI	https://doi.org/10.1016/j.eprac.2025.02.016
Status	Udgivet - maj 2025

Finansiering

Bevillingsgivere	Bevillingsgivernummer
American Association of Oral and Maxillofacial Surgeons
Canadian Association of Oral and Maxillofacial Surgeons
McMaster University

Adgang til dokumentet

10.1016/j.eprac.2025.02.016

Citationsformater

Ali, D. S., Khan, A. A., Morrison, A., Tetradis, S., Mirza, R. D., El Rabbany, M., Abrahamsen, B., Aghaloo, T. L., Al-Alwani, H., Al-Dabagh, R., Anastasilakis, A. D., Bhandari, M., Body, J.-J., Brandi, M. L., Brignardello-Petersen, R., Brown, J. P., Cheung, A. M., Compston, J., Cooper, C., ... Ruggiero, S. L. (2025). 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. Endocrine Practice, 31(5), 686-698. https://doi.org/10.1016/j.eprac.2025.02.016

@article{f09c3210c4d64a81bf7c5fb7efb54659,

title = "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",

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.",

keywords = "Humans, Osteoporosis/drug therapy, Bone Density Conservation Agents/therapeutic use, Dental Implants/adverse effects, Bisphosphonate-Associated Osteonecrosis of the Jaw/etiology, Consensus, Diphosphonates/therapeutic use, Osteoporosis, Mronj, Osteonecrosis of the jaw, Antiresorptive therapy, Dental implants",

author = "Ali, {Dalal S} and Khan, {Aliya A} and Archibald Morrison and Sotirios Tetradis and Mirza, {Reza D} and {El Rabbany}, Mohamed and Bo Abrahamsen and Aghaloo, {Tara L} and Hatim Al-Alwani and Rana Al-Dabagh and Anastasilakis, {Athanasios D} and Mohit Bhandari and Jean-Jacques Body and Brandi, {Maria Luisa} and Romina Brignardello-Petersen and Brown, {Jacques P} and Cheung, {Angela M} and Juliet Compston and Cyrus Cooper and Adolfo Diez-Perez and Ferrari, {Serge L} and Gordon Guyatt and David Hanley and Harvey, {Nicholas C} and Josse, {Robert G} and Kendler, {David L} and Sarah Khan and Sandra Kim and Langdahl, {Bente L} and Christos Magopoulos and Masri, {Basel K} and Morgan, {Sarah L} and Morin, {Suzanne N} and Nicola Napoli and Barbara Obermayer-Pietsch and Andrea Palermo and Jessica Pepe and Edmund Peters and Pierroz, {Dominique D} and Rene Rizzoli and Saunders, {Deborah P} and Stanford, {Clark M} and Riad Sulimani and Akira Taguchi and Sakae Tanaka and Watts, {Nelson B} and Joile Zamudio and Zillikens, {M Carola} and Ruggiero, {Salvatore L}",

year = "2025",

month = may,

doi = "10.1016/j.eprac.2025.02.016",

language = "English",

volume = "31",

pages = "686--698",

journal = "Endocrine Practice",

issn = "1530-891X",

publisher = "Elsevier B.V.",

number = "5",

}

Ali, DS, Khan, AA, Morrison, A, Tetradis, S, Mirza, RD, El Rabbany, M, Abrahamsen, B, Aghaloo, TL, Al-Alwani, H, Al-Dabagh, R, Anastasilakis, AD, Bhandari, M, Body, J-J, Brandi, ML, Brignardello-Petersen, R, Brown, JP, Cheung, AM, Compston, J, Cooper, C, Diez-Perez, A, Ferrari, SL, Guyatt, G, Hanley, D, Harvey, NC, Josse, RG, Kendler, DL, Khan, S, Kim, S, Langdahl, BL, Magopoulos, C, Masri, BK, Morgan, SL, Morin, SN, Napoli, N, Obermayer-Pietsch, B, Palermo, A, Pepe, J, Peters, E, Pierroz, DD, Rizzoli, R, Saunders, DP, Stanford, CM, Sulimani, R, Taguchi, A, Tanaka, S, Watts, NB, Zamudio, J, Zillikens, MC & Ruggiero, SL 2025, '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', Endocrine Practice, bind 31, nr. 5, s. 686-698. https://doi.org/10.1016/j.eprac.2025.02.016

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. / Ali, Dalal S; Khan, Aliya A; Morrison, Archibald et al.
I: Endocrine Practice, Bind 31, Nr. 5, 05.2025, s. 686-698.

Publikation: Bidrag til tidsskrift › Review › Forskning › peer review

TY - JOUR

T1 - Antiresorptive Therapy to Reduce Fracture Risk and Effects on Dental Implant Outcomes in Patients With Osteoporosis

T2 - A Systematic Review and Osteonecrosis of the Jaw Taskforce Consensus Statement

AU - Ali, Dalal S

AU - Khan, Aliya A

AU - Morrison, Archibald

AU - Tetradis, Sotirios

AU - Mirza, Reza D

AU - El Rabbany, Mohamed

AU - Abrahamsen, Bo

AU - Aghaloo, Tara L

AU - Al-Alwani, Hatim

AU - Al-Dabagh, Rana

AU - Anastasilakis, Athanasios D

AU - Bhandari, Mohit

AU - Body, Jean-Jacques

AU - Brandi, Maria Luisa

AU - Brignardello-Petersen, Romina

AU - Brown, Jacques P

AU - Cheung, Angela M

AU - Compston, Juliet

AU - Cooper, Cyrus

AU - Diez-Perez, Adolfo

AU - Ferrari, Serge L

AU - Guyatt, Gordon

AU - Hanley, David

AU - Harvey, Nicholas C

AU - Josse, Robert G

AU - Kendler, David L

AU - Khan, Sarah

AU - Kim, Sandra

AU - Langdahl, Bente L

AU - Magopoulos, Christos

AU - Masri, Basel K

AU - Morgan, Sarah L

AU - Morin, Suzanne N

AU - Napoli, Nicola

AU - Obermayer-Pietsch, Barbara

AU - Palermo, Andrea

AU - Pepe, Jessica

AU - Peters, Edmund

AU - Pierroz, Dominique D

AU - Rizzoli, Rene

AU - Saunders, Deborah P

AU - Stanford, Clark M

AU - Sulimani, Riad

AU - Taguchi, Akira

AU - Tanaka, Sakae

AU - Watts, Nelson B

AU - Zamudio, Joile

AU - Zillikens, M Carola

AU - Ruggiero, Salvatore L

PY - 2025/5

Y1 - 2025/5

N2 - 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.

AB - 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.

KW - Humans

KW - Osteoporosis/drug therapy

KW - Bone Density Conservation Agents/therapeutic use

KW - Dental Implants/adverse effects

KW - Bisphosphonate-Associated Osteonecrosis of the Jaw/etiology

KW - Consensus

KW - Diphosphonates/therapeutic use

KW - Osteoporosis

KW - Mronj

KW - Osteonecrosis of the jaw

KW - Antiresorptive therapy

KW - Dental implants

U2 - 10.1016/j.eprac.2025.02.016

DO - 10.1016/j.eprac.2025.02.016

M3 - Review

C2 - 40335186

SN - 1530-891X

VL - 31

SP - 686

EP - 698

JO - Endocrine Practice

JF - Endocrine Practice

IS - 5

ER -

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

Abstract

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