Bone Healing Around Implants in Normal and Medically Compromised Conditions: Osteoporosis and Diabetes

Osseointegration of orthopedic and dental implants is influenced by local and systemic factors, including their physicochemical surface properties and the patient's overall health status. Titanium and its alloys have been a longstanding standard for bone implants due to their innate biocompatibility and mechanical properties. Beyond material selection, successful integration also depends on mechanical and biological conditions at the implantation site. Initial implant stability, governed by the degree of bone-implant contact at placement, is essential for long-term success. In healthy individuals, bone healing around implants follows a coordinated sequence of cellular and molecular events. However, systemic conditions affecting these events, such as diabetes and osteoporosis, alter bone metabolism, angiogenesis, and immune regulation, thereby compromising osseointegration and increasing the risk of implant failure. Understanding these disease-specific impairments is critical for optimizing implant design and treatment strategies. Advances in surface modification, particularly surface nanotopography, offer promising approaches to modulate bone healing and the potential to compensate for deficiencies resulting from compromised conditions. This review provides a broad overview of current evidence from in vitro, in vivo, and clinical studies to elucidate how diabetes and osteoporosis impact bone integration of implants, explores emerging strategies, and presents perspectives for improving outcomes in medically compromised patients.