Many reports of the relationship between dental implants and osteoporosis have been published, but few have focused on bone quality. Bone quality is multifactorial and difficult to classify because it varies from patient to patient. The present study focused on BTM, which is one of the clinical indicators of bone quality. A prospective study confirmed that elevation of a BTM can predict fracture. It has also been confirmed that BTM elevation is a risk factor for fracture independent of bone density. Moreover, it has been reported that BTM measurements, which are estimates of systemic bone quality, are useful for evaluating periodontal disease and the condition of the jawbone. In the future, evaluations of bone strength in women will require assessments of both bone metabolism markers and the density of cancellous bone.

This study had a limitation; that was the imbalance in the number of the implants between male and female patients. Only two SLA implants in the normal group were placed in women, so we could not separately analyze the data according to the sex of the patients. Further research is needed with a greater sample size of women to validate these results and account for these limitations.

Within the limitations of this study, we found that up to 80% of women in this study, in whom implant treatments were planned, had high serum BTM levels, and that there was no man with abnormal BTM levels. We also showed that the cancellous bone density in patients with a high BTM value was significantly lower than that in patients with a normal BTM value, indicating that the cancellous bone in the abnormal group was poorer than that in the normal group at baseline. Female patients who undergo implant treatments may have reduced bone quality; evaluations of bone strength will require assessments of both BTMs and the density of cancellous bone.