Nine (82%) of the11 female patients in this study had at least one BTM measurement outside the normal range. The abnormal BTM values in these women were pronounced. No abnormal BTM valued were observed among the men. According to the Japanese Guidelines for the Prevention and Treatment of Osteoporosis, the diagnostic criteria for osteoporosis include the following: (1) fragility fractures and low BMD (i.e., nontraumatic bone fractures and a BMD < 80% of the young adult mean) in an adult or (2) a BMD < 70% of the young adult mean without fragility fractures in an adult. Furthermore, the purpose of BTM measurement is to evaluate bone metabolism in patients who have already been diagnosed with osteoporosis; it is not used for diagnostic purposes. Therefore, in this study, patients with abnormal BTM measurements were not referred for consultation with an orthopedist before receiving dental implants unless they had objective or subjective symptoms of osteoporosis. According to our results, slightly greater than 80% of women in this study had high serum BTM levels and none of the male patients had abnormal BTM levels. We found that cancellous bone densities in patients with high BTMs were significantly lower than the cancellous bone densities in patients with normal BTMs. This indicates that the cancellous bone in the group with abnormal BTMs was poorer than that in the group with normal values at baseline.

According to the traditional concept of sexually dimorphic bone growth, male hormones (androgens) stimulate bone growth during puberty, whereas female hormones (estrogens) inhibit bone mineral acquisition. Moreover, men tend to lose less bone than women during the aging process because they do not experience a physiologic equivalent of menopause. The results of our study are consistent with earlier reports. Biochemical BTMs reflect whole-body rates of bone resorption and formation and are likely to reflect changes in the number of bone remodeling sites. Almasoud et al. reported that there was no significant difference in the cancellous bone density in the edentulous sites between the male and female patients. Therefore, we mix-matched the measurements between male and female patients.