Antiosteoporotic Drugs to Promote Bone Regeneration Related to Titanium Implants: A Systematic Review and Meta-Analysis

• Published in: Tissue engineering. Part B, Reviews Reviews, 2019-04, Vol.25 (2), p.89-99
• Main Authors: Basudan, Amani M., Shaheen, Marwa Y., de Vries, Rob B., van den Beucken, Jeroen J.J.P., Jansen, John A., Alghamdi, Hamdan S.
• Format: Article
• Language: English
• Subjects: Animal models; Bias; Bone growth; Bone implants; Coatings; Computed tomography; Dental implants; Dentistry; Drug delivery; Drug dosages; Laboratory animals; Meta-analysis; Osseointegration; Osteoporosis; Quality; Regeneration; Review Articles; Systematic review; Titanium; Transplants & implants
• ISSN: 1937-3368; 1937-3376
• DOI: 10.1089/ten.teb.2018.0120

This meta-analysis was to systematically investigate all preclinical researches on the possible benefits of antiosteoporotic drugs on titanium implants. Also, we performed a subgroup analysis to examine if the methods of drug delivery (systemic vs. local vs. surface coatings) or the types of antiosteoporotic drug (anticatabolic vs. anabolic) have more effect on bone-to-implant regeneration. A total of 116 articles (animal studies) were included. Poor reporting was assessed in the majority of the included studies. Then, results of meta-analysis showed that the use of osteoporotic medications significantly increased the overall values of micro-CT bone volume (BV) (mean differences [MD]: 21.7%, confidence interval [CI]: 17.8–25.7), bone-to-implant contact (BIC) (MD: 12.1%, CI: 10.6–13.7), torque-out (MD: 5.7N.cm, CI: 4.6–6.8), and push-out (MD: 67.3N, CI: 54.6–79.9) compared with the values of implants without osteoporotic medications. Also, implants coated with drugs showed higher values of BIC (MD: 16.8%, CI: 12.4–21.3) compared with implants received drugs through systemic administration (MD: 12.2%, CI: 10.1–14.3) or local administration (MD: 8.6%, CI: 5.8–11.4). A positive effect of local delivery of antiosteoporotic drugs was significant on push-out testing (MD: 169.8N, CI: 120.1–219.6) compared with the use of drugs through systemic route (MD: 51.6N, CI: 38.7–64.6) or as surface coatings (MD: 24.1N, CI: 15.4–32.7). Finally, anabolic drugs showed a significant effect on push-out forces (MD: 125.5N, CI: 95.5–155.5) compared with the use of anticatabolic drugs (MD: 51.9N, CI: 39.5–64.5). In conclusion, the positive effect of antiosteoporotic drugs on osseointegration is observed in the present meta-analysis. Mainly, antiosteoporotic drug-coated implant surfaces showed an increase of BIC% compared with implants received drugs through local routes, but not with systemic routes. Also, the positive effect of anabolic drugs seems beyond the effect of anticatabolic drugs in terms of mechanical stability of implants as tested by push-out.