Osteoporosis International

, Volume 17, Issue 10, pp 1494–1500

Comparative study of axial and femoral bone mineral density and parameters of mandibular bone quality in patients receiving dental implants

  • M. A. L. Amorim
  • L. Takayama
  • V. Jorgetti
  • R. M. R. Pereira
Original Article



In view of the increase in the life expectancy of humans and in edentulism of the population above 50 years of age, in which the prevalence of osteoporosis is also higher, it is fundamental to better understand the effects of systemic bone mass loss on the healing process of dental implants and to determine the quality of the bone that surrounds them. The objective of the present study was to compare systemic osteoporosis (axial and femoral) and parameters of mandibular bone quality, and to evaluate osseointegration in postmenopausal women receiving dental implants.


The sample consisted of 39 women aged 48–70 years, 19 with a densitometric diagnosis of osteoporosis in the lumbar spine and femoral neck and 20 controls with a normal densitometric diagnosis. Bone mineral density was measured in the patients and controls by dual-energy X-ray absorptiometry. Eighty-two osseointegrated dental implants were placed in the mandible, 39 of them in the osteoporosis group and 43 in the control group. Mandibular bone quality was evaluated by classifying mandibular inferior cortical and trabecular bone on panoramic radiographs and by histomorphometric analysis of a mandibular bone biopsy. Osseointegration was analyzed after 9 months.


No significant difference was observed between patients with osteoporosis and controls when comparing individuals with a normal cortex and those with a severely or moderately eroded cortex determined on panoramic radiographs. Histomorphometric analysis also revealed no difference in the parameters of bone formation or resorption between the two groups. Implant failure was observed in only one case.


We conclude that there is no association between systemic osteoporosis (axial and femur) and parameters of poor mandibular bone quality. The loss of one implant (1.2%) is compatible with the literature and cannot be attributed to systemic osteoporosis.


Bone histomorphometry Bone mineral density Dental implant Osseointegration Osteoporosis 


  1. 1.
    Herickson PA, Wallenluis K, Astrand K (1984) The mandibula and osteoporosis. Method for determining mineral content of the mandibula and radius. J Oral Rehabil 1:75–84CrossRefGoogle Scholar
  2. 2.
    August M, Kaban LB (1999) The aging maxillofacial skeleton. In: Rosen CJ, Glowacki J, Bigezikian JP (eds) The aging skeleton. Academic Press, San Diego, pp 359–371CrossRefGoogle Scholar
  3. 3.
    Jaffin RA, Berman CL (1991) The excessive loss of Branemark fixture in type IV bone: a 5-year analysis. J Periodontol 62:2–4PubMedGoogle Scholar
  4. 4.
    Mori H, Manabe M, Kurachi Y, Naguno M (1997) Osseointegration of dental implants in rabbit bone with low mineral density. J Oral Maxill Surg 55:351–361CrossRefGoogle Scholar
  5. 5.
    Von Worwen N, Klausen B, Kollerup G (1994) Osteoporosis: a risk factor in periodontal disease. J Periodontol 65:1134–1138Google Scholar
  6. 6.
    Wakley GK, Baylink DJ (1988) Systemic influences on the bone response to dental and orthopedic implants. J Oral Implantol 14:285–311PubMedGoogle Scholar
  7. 7.
    Friberg B, Ekestube A, Mellstron D, Sennerby L (2001) Branemark implants and osteoporosis: a clinical exploratory study. Clin Implant Dent Relat Res 3:50–56PubMedCrossRefGoogle Scholar
  8. 8.
    Cho P, Schneider GB, Krisan K, Keler JC (2004) Examination of the bone implant interface in experimentally induced osteoporotic bone. Implant Dent 13:79–87PubMedCrossRefGoogle Scholar
  9. 9.
    Kanis JA, Melton LJ, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 8:1137–1141Google Scholar
  10. 10.
    Weber HP, Fiorellini JP, Buser DA (1997) Hard-tissue augmentation for the placement of anterior dental implants. Compend Contin Educ Dent 18:779–784PubMedGoogle Scholar
  11. 11.
    Klemetti E, Kolmakow S, Kroger H (1994) Pantomograph in assessment of the osteoporosis risk group. Scand J Dent 102:68–72Google Scholar
  12. 12.
    Klemetti E, Kolmakow S (1997) Morphology of the mandibular cortex on panoramic radiographs as an indicator of bone quality. Dentomaxillofac Radiol 26:22–25PubMedCrossRefGoogle Scholar
  13. 13.
    Parfitt AM, Drezner MK, Glorieux FH, Kanis JÁ, Malluche H, Meunie PJ, Ott SM, Recker RR (1987) Bone histomorphometry: standardization of nomenclature, symbols, and units. J Bone Mineral Res 2:595–610CrossRefGoogle Scholar
  14. 14.
    Smith DE, Zarb GA (1989) Criteria for success of osseointegrated endosseous implants. J Prosth Dent 62:567–572CrossRefGoogle Scholar
  15. 15.
    Spiekermann H (2000) Implantologia. Translation by Sergio Lian Branco Martins. Artmed, Porto AlegreGoogle Scholar
  16. 16.
    Jovanovic SA (1990) Paradontale aspecten von tandheelkundige implantaten. Tandarstprakti J K 3:16Google Scholar
  17. 17.
    Kribbs PJ, Chesnut CH 3rd, Ott SM, Kilcoyne RF (1989) Relationships between mandibular and skeletal bone in osteoporotic population. J Prosthet Dent 62:703–707PubMedCrossRefGoogle Scholar
  18. 18.
    Kribbs PJ, Chesnut CH 3rd, Ott SM, Kilcoyne RF (1990) Relationships between mandibular and skeletal bone in a population of normal women. J Prosthet Dent 63:86–89PubMedCrossRefGoogle Scholar
  19. 19.
    Mohajery M, Brooks SL (1992) Oral radiographs in the detection of early signs of osteoporosis. Oral Surg Oral Med Pathol 73:112–117CrossRefGoogle Scholar
  20. 20.
    Taguchi A, Tanimoto K, Suei Y, Otani K, Wada T (1996) Relationship between the mandibular and lumbar vertebral bone mineral density at different postmenopausal stages. Dentomaxillofac Radiol 25:130–135PubMedGoogle Scholar
  21. 21.
    Horner K, Delvin H (1998) The relationship between two indices of mandibular bone mineral density measured by dual energy X-ray absorptiometry. Dentomaxillofac Radiol 27:17–21PubMedCrossRefGoogle Scholar
  22. 22.
    Jowitt N, MacFarlane T, Devilin H, Klemetti E, Jorner K (1999) The reproducibility of the mandibular cortex index. Dentomaxillofac Radiol 28:141–144PubMedCrossRefGoogle Scholar
  23. 23.
    Francischone P, Tavano O (2000) Avaliação da perda óssea maxilar pela análise da radiografia panorâmica comparando com a densitometria óssea mandibular e femoral. BCI 7:24–28Google Scholar
  24. 24.
    Bulgarelli AF (2002) Osteoporose: um foco de estudo na odontologia. RPG Rev Pos-Grad 9:379–382Google Scholar
  25. 25.
    White SC (2002) Oral radiographic predictors of osteoporosis. Dentomaxillofac Radiol 31:84–92PubMedCrossRefGoogle Scholar
  26. 26.
    Taguchi A, Sanada M, Krall E, Nakamoto T,Ohtsuka M, Suei Y, Tanimoto K, Kodama I, Tsuda M, Ohama K (2003) Relationship between dental panoramic radiographic findings and biochemical markers of bone turnover. J Bone Miner Res 18:1689–1695PubMedCrossRefGoogle Scholar
  27. 27.
    Taguchi A, Tanimoto K, Suei Y, Otani K, Wada T (1995) Oral signs as indicators of possible osteoporosis in elderly women. Oral Surg Oral Med Pathol 80:612–616CrossRefGoogle Scholar
  28. 28.
    Klemetti E, Kolmakow S, Heiskanen P, Vainio P, Lassila V (1993) Panoramic mandibular index and bone mineral densities in postmenopausal women. Oral Surg Oral Med Pathol 75:774–779CrossRefGoogle Scholar
  29. 29.
    Frost HM (1964) Bone biodynamics. Little Brown, Boston, pp 315–333Google Scholar
  30. 30.
    Thomsen JS, Ebbesen EN, Moseklde L (2002) Static histomorphometry of human iliac crest and vertebral trabecular bone: a comparative study. Bone 30:267–274PubMedCrossRefGoogle Scholar
  31. 31.
    Mohammad AR, Jones JD, Brunsvold MA (1994) Osteoporosis and periodontal disease: a review. CDA J CA Dent Assoc 22:69–75Google Scholar
  32. 32.
    Jeffcoat MK (1998) Osteoporosis: a possible modifying factor in oral bone loss. Ann Periodontol 3:312–321PubMedGoogle Scholar
  33. 33.
    Taguchi A, Tanimoto K, Suei Y, Ohtsuka M, Hollender LG (1999) Relationship between bone mineral density and tooth loss in elderly Japanese women. Dentomaxillofac Radiol 28:219–223PubMedCrossRefGoogle Scholar
  34. 34.
    Albreketsson T, Zarb GA (1989) The Branemark osseointegrated implant. Quintessence, Chicago, 262ppGoogle Scholar
  35. 35.
    Adell R, Lekholm U, Rockler B, Branemark PI (1981) A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 10:387–416PubMedCrossRefGoogle Scholar
  36. 36.
    Branemark P-I, Hansson BO, Adell R, Breine U, Lindström MJ, Hallén O, Ohman A (1977) Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg 16:1–132Google Scholar
  37. 37.
    Strid KG (1985) Radiographic procedures. In: Branemark PI, Zarb GA, Albrektsson T (eds) Tissue- integrated prosthesis. Osseointegration in clinical dentistry. Quintessence, Chicago, pp 317–337Google Scholar
  38. 38.
    Jemt T, Lekholm U, Adell R (1989) Osseointegrated implants in the treatment of partially edentulous patients: a preliminary study on 876 consecutively placed fixture. Int J Oral Maxillofac Implants 4:211–217PubMedGoogle Scholar
  39. 39.
    Adell R, Eriksson B, Lekholm U, Branemark P-I, Jemt T (1990) Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Implants 5:347–359PubMedGoogle Scholar
  40. 40.
    Baxter JC, Fattore L (1993) Osteoporosis and osseointegration of implants. J Prosthodont 2:120–125PubMedCrossRefGoogle Scholar
  41. 41.
    Dao TTT, Anderson JD, Zarb G (1993) Is osteoporosis a risk factor for osseointegration of dental implants? Int J Oral Maxillofac Implants 8:137–144PubMedGoogle Scholar
  42. 42.
    Köndell PA, Nodenran A, Landt H (1988) Titanium implants in the treatment of edentulousness: influence of patients’ age on prognosis. Gerodontics 4:280PubMedGoogle Scholar
  43. 43.
    Zarb GA, Schmitt A (1994) Osseointegration for elderly patients: the Toronto study. J Prosthet Dent 72:559–568PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2006

Authors and Affiliations

  • M. A. L. Amorim
    • 1
  • L. Takayama
    • 1
  • V. Jorgetti
    • 2
  • R. M. R. Pereira
    • 1
    • 3
  1. 1.Division of Rheumatology (Bone Mineral Metabolism Laboratory)University of São PauloSão PauloBrazil
  2. 2.Nephrology Division, School of MedicineUniversity of São PauloSão PauloBrazil
  3. 3.Faculdade de Medicina da Universidade de São PauloSão PauloBrazil

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