Shared molecular framework and bidirectional effects of osteoporosis on periodontal disease and dental implant therapy in the elderly

OBJECTIVES: This review synthesizes evidence regarding the prevalence, epidemiological associations, and mechanistic pathways between osteoporosis, periodontal disease, and dental implant therapy. MATERIALS AND METHODS: A literature review was conducted to identify studies focused on: osteoporosis, periodontal disease, and dental implants. Studies were categorized into: epidemiological, clinical, in vivo, and in vitro studies. RESULTS: Osteoporosis and periodontal disease are inflammation-associated conditions prevalent in the elderly that share common risk factors, molecular framework, and effects on periodontal breakdown and implant outcomes. Low bone mineral density is linked to increased periodontal destruction, notably in postmenopausal women. Osteoporotic individuals exhibit 1.13 to 2.63 increased odds of having periodontitis. Clinical studies show implant survival remains high in osteoporotic patients, though it is modestly reduced to 94%. Anti-resorptive therapies protect against bone loss but are associated with the risk of osteonecrosis. In vivo models reveal worsened periodontitis progression under osteoporotic conditions. Biologic agents, such as sclerostin-neutralizing antibodies, are beneficial for disease management and bone regeneration in osteoporotic models. In vitro research examining mechanisms of altered bone metabolism has identified potential therapeutic targets for bone diseases, such as human periodontal ligament-derived mesenchymal stem cells and microbe-associated molecular patterns. CONCLUSIONS: Osteoporosis may increase susceptibility for periodontitis and peri-implant bone loss, though implant therapy and periodontal regeneration may still be possible through proper and interdisciplinary treatment planning. CLINICAL RELEVANCE: Studies on the relationship between osteoporosis, periodontitis, and dental implant therapy emphasize the importance of integrative care. Risk factor identification and careful treatment planning are imperative to optimize clinical outcomes.