(P07) Healing in Osteoporotic Bone: An Evaluation of the Role of Bisphosphonates and Platelet-rich Fibrin (PRF) in Peri-implant Outcomes

Purpose of the Study: Dental implants are regarded as a standard of care for tooth replacement due to their high success rates and ability to restore oral function and esthetics. However, the challenge of peri-implant bone preservation is magnified in aging populations [1], where bone remodeling slows, and systemic conditions such as osteoporosis or endocrine imbalances further compromise bone quality [2]. Bisphosphonates, widely used in osteoporosis and malignancy-related bone disease, reduce bone turnover and have been linked to osteonecrosis of the jaw (ORNJ) [2-4], particularly in high-dose intravenous (IV) regimens but also, though less frequently, in long-term oral therapy[4]. Identifying patients at risk, stratifying based on drug route, dose, and duration, and applying adjunctive therapies are critical to safe implant placement [1]. Platelet-rich fibrin (PRF), prepared through various centrifugation techniques (e.g., L-PRF, A-PRF), has demonstrated potential to enhance angiogenesis, growth factor release, and osseointegration in compromised bone, though technique-specific differences may influence outcomes [5].

Methods: A focused literature review was conducted using PubMed and Google Scholar to evaluate the role of PRF in implant healing among bisphosphonate users and osteoporotic bone. Search terms included “osteoporosis,” “bisphosphonates,” “platelet-rich fibrin,” and “dental implants.” Studies were filtered to include systematic reviews, RCTs, and clinical cohorts published within the last 5 years. Key variables extracted included bisphosphonate type (IV vs oral), treatment duration, PRF preparation protocol, and implant healing outcomes.

Results: Evidence suggests that PRF improves bone and soft-tissue healing in compromised bone [6-10]. In osteonecrosis cases, L-PRF combined with adjunctive therapies achieved up to 94.3% lesion resolution, outperforming single therapies [11]. PRF enhances angiogenesis, cellular proliferation, and matrix deposition, promoting osseointegration [10]. However, clinical outcomes vary depending on PRF technique and patient medication profile. Risk stratification for bisphosphonate-associated ORNJ is enhanced by medical laboratory markers such as serum NTx and urine CTx, which reflect bone turnover and may guide surgical planning.

Conclusion: PRF represents a promising adjunct for implant placement in patients on bisphosphonate therapy, mitigating risks of compromised osseointegration and ORNJ [6-10]. Clinical decision-making should include: (1) differentiation between oral and IV bisphosphonate users, including dosage and duration; (2) specification of PRF protocol used to ensure reproducibility; and (3) incorporation of bone turnover markers (serum NTx, urine CTx) [12] to assess patient-specific risk before surgery. Standardizing such protocols could improve safety, predictability, and patient outcomes in implant therapy for medically complex populations.

Articles: 4. Drake, M.T., B.L. Clarke, and S. Khosla, Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc, 2008. 83(9): p. 1032–45.
5. Dohan Ehrenfest, D.M., L. Rasmusson, and T. Albrektsson, Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol, 2009. 27(3): p. 158–67.
6. Amiri, M.A., et al., The Potential Therapeutic Effects of Platelet-Derived Biomaterials on Osteoporosis: A Comprehensive Review of Current Evidence. Int J Biomater, 2023. 2023: p. 9980349.
7. Crupi, A., et al., Dental Implant Survival and Risk of Medication-Related Osteonecrosis in the Jaws in Patients Undergoing Antiresorptive Therapy: A Systematic Review. Int J Mol Sci, 2025. 26(8).
8. Durmuşlar, M.C., et al., The effect of injectable platelet-rich fibrin in combination with autogenous bone grafts on bone healing in an ovariectomized osteoporotic rat model with critical-sized defects. Saudi Med J, 2024. 45(8): p. 791–798.
9. Nisi, M., et al., Clinical and radiologic treatment outcomes of implant presence tirggered-MRONJ: Systematic review of literature. Oral Dis, 2024. 30(8): p. 5255–5267.
10. Steller, D., et al., Impacts of platelet-rich fibrin and platelet-rich plasma on primary osteoblast adhesion onto titanium implants in a bisphosphonate in vitro model. J Oral Pathol Med, 2019. 48(10): p. 943–950.
11. Muñoz-Salgado, A., et al., Leukocyte and platelet rich fibrin in the management of medication-related osteonecrosis of the jaw: A systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal, 2023. 28(4): p. e317–e329.
12. Yarom, N., et al., MASCC/ISOO Clinical Practice Statement: imaging and clinical laboratory tests in the diagnosis and management of medication-related osteonecrosis of the jaw. Support Care Cancer, 2025. 33(10): p. 852.

Books: 1. Misch CE. Contemporary implant dentistry. 3rd ed. St. Louis, MO: Mosby Elsevier; 2008.

2.Kumar V, Abbas AK, Aster JC, Turner JR. Robbins & Cotran pathologic basis of disease. 10th ed. Philadelphia, PA: Elsevier; 2011.

3.Katzung BG, Volger TW. Agents that affect bone mineral homeostasis. In: Katzung BG, ed. Basic & clinical pharmacology. New York, NY: McGraw Hill; 2021:798-822.