Bisphosphonates can reduce or even suppress osteoclast function and due to this effect it has been used to treat various disorders that cause abnormal bone resorption. In the 1980’s, bisphosphonates administered by the intravenous (IV) route were initially used for the treatment of malignancies affecting the bone tissue, such as multiple myeloma and bone metastases of breast and prostate cancer. However, the relatively recent introduction of IV and oral bisphosphonates for the treatment and prevention of osteoporosis has expanded the application of these medications to a significant proportion of the adult population.
It is not uncommon for post menopausal women to be on these medications at the slightest indication of osteopenia. Loss of osseointegrated implants in association with bisphosphonate therapy was reported by several groups including one from Rutgers University where Dr. Shankar Iyer provided 2 case report of full arch implant failures. This case is one where in the patient had loss of a block graft with continued IV bisphonate use. Not surprisingly, early studies focused on positive outcomes from the use of these drugs in conjunction with implant therapy, such as increasing the contact between bone and implant, however there are few studies that have had long term follow ups.
The patient is an 83 year old Caucasian female who received several implants and a block graft. After 4 months, most of the implants integrated into native bone, but the block graft was delaminated and had to be removed. Caution should be exercised in performing extensive grafting procedures in patients who are receiving IV bisphosphonate therapy.