Bone Density Screening and Re-screening in Postmenopausal Women and Older Men

The implication of calf circumference and grip strength in osteoporosis and bone mineral density among hemodialysis patients

BACKGROUND

Chronic kidney disease-mineral and bone disorder (CKD-MBD), nutritional status, and uremia management have been emphasized for bone management in hemodialysis patients. Nevertheless, valuable data on the importance of muscle mass in bone management are limited, including whether conventional management alone can prevent osteoporosis. Thus, the importance of muscle mass and strength, independent of the conventional management in osteoporosis prevention among hemodialysis patients, was evaluated.

METHODS

Patients with a history of hemodialysis 6 months or longer were selected. We assessed the risk for osteoporosis associated with calf circumference or grip strength using multivariable adjustment for indices of CKD-MBD, nutrition, and dialysis adequacy. Moreover, the associations between bone mineral density (BMD), calf circumference, grip strength, and bone metabolic markers were also evaluated.

RESULTS

A total of 136 patients were included. The odds ratios (95% confidence interval) for osteoporosis at the femoral neck were 1.25 (1.04-1.54, P < 0.05) and 1.08 (1.00-1.18, P < 0.05) per 1 cm shorter calf circumference or 1 kg weaker grip strength, respectively. Shorter calf circumference was significantly associated with a lower BMD at the femoral neck and lumbar spine (P < 0.001). Weaker grip strength was also associated with lower BMD at the femoral neck (P < 0.01). Calf circumference or grip strength was negatively correlated with bone metabolic marker values.

CONCLUSION

Shorter calf circumference or weaker grip strength was associated with osteoporosis risk and lower BMD among hemodialysis patients, independent of the conventional therapies.

Risk factors and strategies for recovery quality, postoperative pain, and recurrent fractures between percutaneous kyphoplasty and percutaneous vertebroplasty in elderly patients with thoracolumbar compression fractures: a retrospective comparative cohort study

Background

With the increase of clinical cases and the improvement of operation, we found that recurrent fracture of the adjacent vertebral body is a common long-term complication of percutaneous kyphoplasty (PKP). However, the mechanism of re-fracture of adjacent vertebrae after PKP has not been unified. Therefore, through retrospective study, this paper discussed the risk factors and countermeasures affecting the quality of rehabilitation, postoperative pain and recurrent fracture in elderly PKP patients.

Methods

From December 2019 to May 2021, 313 patients with osteoporotic spinal fractures were analyzed retrospectively. Cases were allocated to percutaneous vertebroplasty (PVP; n=130) and PKP (n=183) groups according to the modes of operation. Visual analogue scale (VAS), Cobb angle, and Oswestry disability index (ODI) were evaluated. Based on the occurrence of new fractures, the PKP cohort (n=15) and control cohort (n=32) were classified. Questionnaires analyzed the postoperative re-fractures of people with different characteristics, and the influencing factors of postoperative re-fracture were measured by multivariate logistic regression analysis.

Results

The postoperative VAS scores were significantly lower in the PKP group. The ODI scores in the PKP group were considerably lower than those in the PVP group after surgery. Univariate analysis indicated that age, number of injured vertebrae, history of complicated fracture, number of operative vertebrae, and bone mineral density (BMD) were remarkably correlated with recurrent fracture after PKP. Logistic regression analysis indicated that age, operative vertebral body, BMD, and the number of injured vertebrae were independent risk factors for recurrent fracture after PKP. BMI, BMD, low back soft tissue injury, postoperative vertebral height recovery rate, sagittal Cobb angle improvement rate, total diffusion coefficient of bone cement, short-term complications, non-union, and recurrent fracture were the main risk factors of residual low back pain after PKP.

Conclusions

The clinical efficacy of PKP in elderly patients with thoracolumbar vertebral compression fracture is superior to that of PVP. Clinical attention should be paid to identifying high-risk factors for complications after PKP, and preventive measures should be implemented to help reduce the occurrence of recurrent fractures and postoperative residual pain.

Screening for osteoporosis using L1 vertebral density on abdominal CT in an Australian population

AIM

To assess the utility of osteoporosis screening using abdominal computed tomography (CT) versus dual-energy X-ray absorptiometry (DXA) T-scores as the reference.

MATERIALS AND METHODS

Patients ≥30 years undergoing abdominal CT and DXA within 12 months were assessed retrospectively. Bone mineral density (BMD) was measured using axial CT attenuation at L1, correlating with DXA T-scores. Sensitivity, specificity, area under the curve (AUC), and odds ratio (OR) were calculated.

RESULTS

The study cohort comprised 407 CT-DXA pairs (58.2% women). The prevalence of osteoporosis was 11.8%. L1 density and T-score were significantly correlated in both women (r=0.35, p<0.001) and men (r=0.15, p=0.04). The AUC to distinguish osteoporosis from osteopenia and normal BMD was 0.64 (95% CI: 0.56-0.71). In women, a threshold of 190 HU detected T-scores ≤ -2.5 with a negative predictive value (NPV) of 94.4% (OR=4.4, p<0.01). In the entire cohort, a threshold of 180 HU detected T-scores ≤ -2.5 with a NPV of 96.2% (OR=4.7, p<0.01).

CONCLUSIONS

CT L1 attenuation correlates with L1 DXA T-scores. Density values < 190 and 180 HU increased the probability of an osteoporosis diagnosis in Australian women and the overall cohort, respectively. Opportunistic screening for osteoporosis using abdominal CT is feasible, enabling identification of at-risk subjects for formal DXA imaging, thereby improving treatment initiation and reducing fracture risk.

Schmorl's nodes could be associated with intervertebral disc degeneration at upper lumbar levels and end-plate disease at lower lumbar level in patients with low back pain

Schmorl's nodes (SNs) have increasingly been recognized on vertebral end-plates using advanced imaging techniques. Even though vertebral end-plates are the closest structures to discs, their pathologies are underestimated in the etiology of low back pain (LBP). We aimed to detect the prevalence of SNs and other end-plate defects in subjects with/without LBP and to understand whether SNs were associated with LBP and spinal degeneration. Subjects were evaluated in terms of end-plate defects, intervertebral disc degeneration (IVDD), and vertebral end-plate changes (Modic changes) at all lumbar levels on lumbar spine magnetic resonance imagings (MRI). Control subjects were compared to patients with LBP. Higher Pfirrmann scores (OR: 2.696) and higher SN scores (OR: 8.076) were significantly associated with Modic changes at L4-L5 disc level. Patients with higher SN scores at L1-L2 or L2-L3 levels had approximately 7-fold increased risk of severe IVDD at the corresponding levels. The most significant factor associated with presence of SNs was body weight of the patients (OR: 1.417). The most significant factor associated with intensity of LBP was severe IVDD at L5-S1 level (OR: 3.670). Having higher total SN score had an OR of 1.230 (95% CI: 1.003-1.509; p = 0.047) for predicting LBP. Schmorl's nodes were seen in 33.1% of patients and 11.5% of asymptomatic subjects. Body weight was the most significant factor associated with SNs. The most significant factor associated with LBP was severe IVDD at L5-S1 level.

Elevated blood pressure, antihypertensive medications and bone health in the population: revisiting old hypotheses and exploring future research directions

Blood pressure and bone metabolism appear to share commonalities in their physiologic regulation. Specific antihypertensive drug classes may also influence bone mineral density. However, current evidence from existing observational studies and randomised trials is insufficient to establish causal associations for blood pressure and use of blood pressure-lowering drugs with bone health outcomes, particularly with the risks of osteoporosis and fractures. The availability and access to relevant large-scale biomedical data sources as well as developments in study designs and analytical approaches provide opportunities to examine the nature of the association between blood pressure and bone health more reliably and in greater detail than has ever been possible. It is unlikely that a single source of data or study design can provide a definitive answer. However, with appropriate considerations of the strengths and limitations of the different data sources and analytical techniques, we should be able to advance our understanding of the role of raised blood pressure and its drug treatment on the risks of low bone mineral density and fractures. As elevated blood pressure is highly prevalent and blood pressure-lowering drugs are widely prescribed, even small effects of these exposures on bone health outcomes could be important at a population level.

Adherence to Daily, Weekly, and Monthly Dosing Regimens of Bisphosphonates for Osteoporosis Treatment in Postmenopausal Women in Japan: A Retrospective Study Using Claims Data

Poor medication adherence of osteoporosis patients is a major global medical problem because of its negative impact on health outcomes and quality of life. The aim of this study was to evaluate how differences in dosing regimens influence adherence to oral bisphosphonates using data from a large health insurance provider in Japan. This was a retrospective observational study using claims data obtained between October 2012 and January 2018, from the community-based National Health Insurance program of a large city in Japan. The data included in the analysis were obtained from women 60 to 74 years old whose oral bisphosphonate prescription was detected between April 2013 and February 2017. Treatment adherence was monitored from the initial prescription for one year, i.e., up to January 2018. Primary comparisons among the daily-dosing, weekly-dosing, and monthly-dosing groups were based on the mean medication possession ratio (MPR). Data from a total of 3,958 patients were analyzed. The numbers of patients aged 60-64, 65-69, and 70-74 were 425, 1,400, and 2,133, respectively. The highest mean MPR was 69.4% for the monthly-dosing of bisphosphonates, followed by the weekly-dosing at 63.5%, and daily-dosing at 57.2%. Using the Kruskal-Wallis test with Dunn-Bonferroni correction, there were significant differences in mean MPR for daily versus weekly (p < 0.01), daily versus monthly (p < 0.001), and weekly versus monthly dosing regimens (p < 0.05). These results suggest significantly more patients adhere to a monthly or weekly regimen of bisphosphonates in the treatment of osteoporosis than to a daily regimen.

Protective effects of berberine on senile osteoporosis in mice

INTRODUCTION

The incidence of osteoporosis is positively correlated with age. Berberine has been reported to treat osteoporosis due to its beneficial actions on bone formation. However, the direct effects of berberine on senile osteoporosis remain unclear. The present study investigated the protective effects of berberine on senile osteoporosis in mice and preliminarily evaluated its potential mechanism.

MATERIALS AND METHODS

20-month-old male C57BL/6 J mice were used as senile osteoporosis mouse model and treated with strontium ranelate (SR) or berberine or solvent control by daily gavage for 2 months. Thereafter, bone mass and microstructure parameters were assessed. Histological staining was performed to identify the osteogenic, adipogenic and osteoclastic activity of bone tissue. Moreover, role of cAMP/PKA/CREB signaling pathway in berberine affecting bone marrow mesenchymal stem cells (BMSCs) differentiation was clarified by enzyme-linked immunosorbent assay and western blot analysis.

RESULTS

The results showed that the SR-treated group displayed a high trabecular bone mass phenotype. For mice administrated with berberine, cancellous bone mass was upregulated in a dose-dependent manner, as indicated by gradually increased bone mass, trabecular bone volume fraction and trabecular number. Furthermore, berberine promotes osteogenic and inhibits adipogenic differentiation of BMSCs via cAMP/PKA/CREB signaling. Also, bone resorption effect becomes more obvious with increasing dose of berberine in vitro.

CONCLUSION

The present results suggest that berberine exerts potent bone protective effects by promoting bone formation, inhibiting marrow fat accumulation and bone resorption. This effect may be achieved through cAMP/PKA/CREB signaling pathway.

Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society

OBJECTIVE

To review evidence regarding osteoporosis screening, prevention, diagnosis, and management in the past decade and update the position statement published by The North American Menopause Society (NAMS) in 2010 regarding the management of osteoporosis in postmenopausal women as new therapies and paradigms have become available.

DESIGN

NAMS enlisted a panel of clinician experts in the field of metabolic bone diseases and/or women's health to review and update the 2010 NAMS position statement and recommendations on the basis of new evidence and clinical judgement. The panel's recommendations were reviewed and approved by the NAMS Board of Trustees.

RESULTS

Osteoporosis, especially prevalent in older postmenopausal women, increases the risk of fractures that can be associated with significant morbidity and mortality. Postmenopausal bone loss, related to estrogen deficiency, is the primary contributor to osteoporosis. Other important risk factors for postmenopausal osteoporosis include advanced age, genetics, smoking, thinness, and many diseases and drugs that impair bone health. An evaluation of these risk factors to identify candidates for osteoporosis screening and recommending nonpharmacologic measures such as good nutrition (especially adequate intake of protein, calcium, and vitamin D), regular physical activity, and avoiding smoking and excessive alcohol consumption are appropriate for all postmenopausal women. For women at high risk for osteoporosis, especially perimenopausal women with low bone density and other risk factors, estrogen or other therapies are available to prevent bone loss. For women with osteoporosis and/or other risk factors for fracture, including advanced age and previous fractures, the primary goal of therapy is to prevent new fractures. This is accomplished by combining nonpharmacologic measures, drugs to increase bone density and to improve bone strength, and strategies to reduce fall risk. If pharmacologic therapy is indicated, government-approved options include estrogen agonists/antagonists, bisphosphonates, RANK ligand inhibitors, parathyroid hormone-receptor agonists, and inhibitors of sclerostin.

CONCLUSIONS

Osteoporosis is a common disorder in postmenopausal women. Management of skeletal health in postmenopausal women involves assessing risk factors for fracture, reducing modifiable risk factors through dietary and lifestyle changes, and the use of pharmacologic therapy for patients at significant risk of osteoporosis or fracture. For women with osteoporosis, lifelong management is necessary. Treatment decisions occur continuously over the lifespan of a postmenopausal woman. Decisions must be individualized and should include the patient in the process of shared decision-making.

Gender Disparities in Osteoporosis Screening and Management Among Older Adults

INTRODUCTION

One in two women and one in four men experience an osteoporosis-related fracture in their lifetime. Related morbidity and mortality rates are higher in men versus women. Current guidelines are inconsistent in the screening recommendations for osteoporosis in men. Examination of gender disparities in the management of osteoporosis-related fractures among Medicare enrollees is currently lacking.

METHODS

In this retrospective cohort study using 5% National Medicare claims data from January 1, 2012 through December 31, 2016, eligible patients who were at least 65 years of age on the date of a new fracture episode were classified into two mutually exclusive cohorts on the basis of whether they received testing and/or treatment for osteoporosis in the 6-month period after the new fracture episode. The cohorts were defined on the basis of the National Committee for Quality Assurance (NCQA) quality measure "osteoporosis management in women who had a fracture." Patients were followed to identify the occurrence of subsequent fracture, all-cause mortality, and a composite outcome-defined as the first occurrence of either subsequent fracture or mortality. Logistic regression models were carried out to identify predictors of testing and/or treatment and time-varying survival analysis to identify the relationship between the presence of testing and/or treatment and patient outcomes.

RESULTS

Of the 35,774 eligible patients, only 10.2% (12.1% women and 5.7% men) received osteoporosis testing and/or treatment within 6 months after a fracture. The interaction between gender and fragility fracture was significant (P < 0.0001). Fragility fracture had greater adjusted odds of testing and/or treatment among men (adjusted odds ratio [AOR] 3.47; 95% CI 2.94-4.10) than women (AOR 1.65; 95% CI 1.53-1.79). Of patients who were eligible for the outcome assessment, 27.5% experienced a subsequent fracture, 23.2% died, and 44.3% experienced a composite outcome during follow-up. Patients who received testing and/or treatment had a significantly lower hazard of all-cause mortality (hazard ratio [HR] 0.57; 95% CI 0.50-0.65; P < 0.0001) and the composite outcome (HR 0.42; 95% CI 0.39-0.45; P < 0.0001), but no difference in the risk of subsequent fracture (HR 1.02; 95% CI 0.94-1.11; P = 0.6083). Men were found to have a significantly lower hazard of subsequent fracture (HR 0.69; 95% CI 0.64-0.73; P < 0.0001), all-cause mortality (HR 0.67; 95% CI 0.61-0.72; P < 0.0001), and the composite outcome (HR 0.69; 95% CI 0.65-0.73; P < 0.0001).

CONCLUSION

Testing and/or treatment for osteoporosis among older adults with a fracture is poor in the Medicare fee-for-service population overall and worse for men compared to women. Receiving appropriate testing and/or treatment was associated with reduced mortality and the risk of composite outcome. Improving osteoporosis testing and/or treatment and reducing health disparities are essential for managing the clinical and economic burden of osteoporosis in the USA.

Potential cause affecting bone quality in Saudi Arabia: New insights

Background

Osteoporosis (OP) is a silent systemic disease characterized by decrements in bone mineral density (BMD) and bone microstructure. This study aimed to determine the status of bone quality as well as to investigate the relationship between the glycaemic; lipid; bone profiles; and the BMD.

Methods

A retrospective study was conducted at KFHU, Al Khobar, Saudi Arabia analysis of patients who underwent BMD testing between the periods of 2016 to 2018. Based on the T scores, patients were classified as follows: normal (>-1.0), osteopenic (-1.0 to -2.5), or osteoporotic (≤-2.5). Details about medical and demographic information as well as metabolic and bone profiles (fasting blood glucose [FBG], glycated haemoglobin [HbA1c], cholesterol [Chol], high-density lipoprotein [HDL], low-density lipoprotein [LDL], triglycerides [TG], calcium [Ca], phosphorus [Ph], alkaline phosphatase [ALP], vitamin D 25OHD [Vit D]) were extracted from the medical records system.

Results

Out of 4838 extracted profiles, there were 4196 females (85.1%). The mean glycaemic variables of patients showed an abnormal profile (FBG 118 ± 49 and HbA1c 6.6 ± 2). The mean T score showed that the majority of patients had either osteopenic (40%) or osteoporotic (24%) changed. Significant increase in mean HbA1c (7.6 ± 1.7) was obvious among the osteopenic patients when judged against the normal (7.5 ± 1.6; P < 0.033) and osteoporotic (7.4 ± 1.8; P < 0.037). Meanwhile, the mean serum ALP was significantly lower (81 ± 26) in the normal group than in the osteopenic (86 ± 33; P < 0.006) and osteoporotic groups (90 ± 40; P < 0.001). Finally, a linear, logistic regression analysis was found that Ca and ALP levels were significant predictors.

Conclusion

This study finds that the main cause that affects bone quality in Saudi Arabia is diabetes mellitus and/or its related metabolic alteration. These results suggest that bone health is clinically significant and should be carefully assessed in diabetes patients.

Association of Hypertension and Lipid Profile with Osteoporosis

BACKGROUND

Hypertension (HTN) and osteoporosis (OP) are common diseases that adversely affect the health-related quality of life among the elderly. However, there is a scarcity of literature on the association between HTN and OP.

OBJECTIVE

The aims of this study were to investigate the association between HTN and antihypertensive drugs (AHT), with bone mineral density (BMD) T-scores, as well as to determine the status of bone quality in Saudi Arabia.

METHOD

A retrospective study was conducted at King Fahd Hospital of the University, Khobar, Saudi Arabia, during 2016 to 2018. BMD was measured using dual-energy X-ray absorptiometry (DEXA). T-score values were used for the diagnosis of osteoporosis. HTN diagnosis and medications, laboratory, and radiology results were collected from the hospital record system.

RESULTS

Out of 1332 extracted profiles, 1103 (82.8%) were females. Based on the T-score, the majority of patients either had osteopenia (41.1%) or was osteoporotic (27.8%). The present study found that there is a significant increase in serum lipids and alkaline phosphatase (ALP) in the osteoporotic group when compared with normal and osteopenia groups. Furthermore, it was found that ALP and Ca levels were significant predictors for OP. Pearson's correlation test revealed a significant negative correlation between HTN and BMD T-score. However, the study reported a nonsignificant association between AHT and BMD T-score.

CONCLUSION

We conclude that controlling both HTN and dyslipidemia might improve bone health. Every osteoporotic patient should be screened for dyslipidemia. Early detection and appropriate management for OP are highly recommended in Saudi Arabia, especially amongst the high-risk group.

Noncoding RNA miR-205-5p mediates osteoporosis pathogenesis and osteoblast differentiation by regulating RUNX2

As a kind of noncoding RNAs, microRNAs (miRNAs) play important roles in disease pathogenesis by regulating gene expression. However, the molecular mechanism of miRNAs in osteoporosis remains largely unknown. In the present study, we aim to explore the genome-wide miRNAs expression profile and the regulatory mechanism of miR-205-5p in osteoporosis. A total of 72 differentially expressed miRNAs were identified in osteoporosis via microarray technology and bioinformatics analysis. We focused on one of the abnormally expressed miRNAs, miR-205-5p, which was previously unknown in osteoporosis. Quantitative real-time polymerase chain reaction (qRT-PCR) results showed that miR-205-5p was upregulated in osteoporosis samples and its expression was gradually decreased during osteogenic differentiation. Besides, miR-205-5p overexpression could inhibit the activity of osteoblast markers, including collagen, type I, α 1 (COL1A1) and alkaline phosphatase (ALP) while miR-205-5p inhibition showed the opposite results. Moreover, bioinformatics analysis identified the potential targets of miR-205-5p, including runt-related transcription factor 2 (RUNX2), SMAD1 and BCL6, etc. The dual-luciferase reporter assay confirmed RUNX2 was directly targeted by miR-205-5p. Furthermore, the rescue experiments showed that RUNX2 overexpression could significantly weaken the effect of miR-205-5p on osteoblast markers, indicating that miR-205-5p may inhibit osteogenic differentiation by targeting RUNX2.

A join point regression analysis of trends in mortality due to osteoporosis in Spain

Osteoporosis is a major health problem in terms of fracture probability and disability. The aim of this ecological study is to identify the temporal trends in osteoporosis mortality in Spain from 1999 to 2015. Data on the Spanish population and number of deaths due to osteoporosis were obtained from the Spanish National Institute for Statistics. Age-adjusted mortality rates were estimated. Join point regression was used to identify the years when changes in mortality s and annual percentage change in mortality rates took place. Women presented a greater mortality rate decrease (p < 0.001), though this mortality difference by sex was reduced by half at the end of the period. The higher the age, the faster the mortality rate declined in women, while no clear pattern could be identified in men. In women, significant changes in trends were identified in three age groups (50-54, 60-64 and 80-84 years old). A sustained decrease in osteoporosis-associated mortality was found in women aged 75-79 and ≥85 years and men aged 60-64. In conclusion, mortality caused by osteoporosis in Spain is decreasing faster in the older age ranges especially in women.

Optimal follow-up intervals for different stages of chronic kidney disease: a prospective observational study

Background

Chronic kidney disease (CKD) is a public health challenge; however, evidence-based, optimal follow-up intervals for patients with CKD have not been identified. This study aimed to identify appropriate follow-up intervals for different stages of CKD.

Methods

We studied 2682 patients with CKD. The number of patients experiencing a 50% increase in creatinine and those reaching end-stage renal failure were examined on the basis of their CKD stage. The renal function testing interval was defined as the estimated time for 0.1% of the patients with CKD to have a composite renal outcome, after adjusting for clinical risk factors. Transitions from CKD stage-based subgroups were analyzed using parametric cumulative incidence models. Other sensitivity analyses involved estimation of the time to renal event occurrence for 1% of patients.

Results

Of the 913 patients (34%) who had a composite renal event, 29 had stage 3A (10.5%), 151 had stage 3B (16.3%), 429 had stage 4 (41.0%), and 304 had stage 5 CKD (70.9%). The estimated renal function testing intervals for patients with CKD were 6.0 months for stage 3A, 3.4 months for stage 3B, 2.0 months for stage 4, and 1.2 months for stage 5.

Conclusions

The optimal follow-up intervals were longer for patients with lower CKD stages. These estimates are longer than those recommended by the current guidelines and serve as a reference for nephrologists in selecting an appropriate follow-up interval for each patient.

Trial registration

UMIN clinical trial registry number: UMIN000020038.

Electronic supplementary material

The online version of this article (10.1007/s10157-018-01684-4) contains supplementary material, which is available to authorized users.

A Prospective, Controlled, Multicenter Study to Evaluate the Clinical Outcome of Implant Treatment in Women with Osteoporosis/Osteopenia: 5-Year Results

The impact of osteoporosis on implant treatment is still a matter of debate in the scientific community, as it may possibly lead to higher failure rates. As long-term controlled trials are missing, the aim of this study was to verify the long-term outcome of implants placed in patients with systemic osteoporosis. Postmenopausal women in need of implants underwent bone mineral density measurements in hip and spine, using dual X-ray absorptiometry scans. Based on T-scores, they were divided into 2 groups: group O (osteoporosis group) with a T-score ≤-2 or group C (control group) with a T-score of ≥-1. Implants were placed in a 2-stage manner and loaded 4 to 8 wk after abutment surgery. Six months after loading and thereafter yearly, clinical and radiographical parameters were assessed. In total, 148 implants were placed in 48 patients (mean age: 67 y [range, 59-83]). Sixty-three implants were placed in 20 patients (group O) and 85 implants in 28 patients (group C). After 5 y, 117 implants (38 in group O and 79 in the group C) in 37 patients were assessed. Cumulative survival rate on an implant level was 96.5% (group O: 91.5%; group C: 100.0% [ P < 0.05]) and 95.7% (group O: 89.2%; group C: 100.0% [ P > 0.05]) on a patient level. The overall marginal bone-level alterations, after 5 y of loading, were -0.09 ± 0.78 mm (group O: -0.15 ± 0.50 mm; group C: -0.06 ± 0.89 mm) on an implant level and -0.09 ± 0.54 mm (group O: -0.18 ± 0.43 mm; group C: 0.06 ± 0.58 mm) on a patient level ( P > 0.05). Oral implant therapy in osteoporotic patients is a reliable treatment option with comparable osseointegration rates, implant survival, and marginal bone-level alterations after 5 y of functional loading (ClinicalTrials.gov NCT00745121).