Impact of Osteoporosis on Dental Implant Survival, Failure, and Marginal Bone Loss: A Systematic Review and Meta-Analysis

Abstract

Featured Application: This meta-analysis indicates that osteoporosis alone does not compromise dental implant outcomes, supporting safe and predictable implant therapy in older adults when guided by careful assessment and individualized planning. Background: The influence of osteoporotic conditions on dental implant outcomes remains uncertain, with conflicting evidence regarding implant survival, failure, and marginal bone loss. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines (PROSPERO: CRD420251021400). PubMed and Scopus databases were searched for comparative human studies published between 2014 and 2024. Eligible studies compared implant outcomes in osteoporotic and non-osteoporotic patients. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models. Results: Fourteen studies met the inclusion criteria, and seven provided sufficient data for quantitative synthesis. The pooled analysis demonstrated no significant difference in implant survival between patients with osteoporotic conditions and control groups (RR = 1.00, 95% CI: 0.97–1.02). Implant failure rates were also comparable (RR = 0.96, 95% CI: 0.59–1.56). Marginal bone loss showed no significant difference (MD = 0.22 mm, 95% CI: −1.69 to 2.12); however, substantial heterogeneity (I2 = 86%) was observed, requiring cautious interpretation. Conclusions: Osteoporotic conditions alone do not appear to negatively affect dental implant survival or failure. However, limited evidence and methodological variability highlight the need for prospective, standardized trials to confirm these findings and to clarify the role of antiresorptive therapy.