Background Bisphosphonates (BPs) are potent inhibitors of bone resorption widely used to manage metabolic bone disorders including osteoporosis, Paget’s disease, and malignant bone disease. With a growing number of adult patients undergoing orthodontic treatment while receiving BP therapy, understanding the interaction between these medications and orthodontic tooth movement (OTM) is of clinical importance. Objective To synthesise the evidence from published systematic reviews on the effect of bisphosphonates on orthodontic tooth movement, orthodontic anchorage, and root resorption. Materials and methods A systematic search of MEDLINE via OVID, PubMed, EMBASE, Scopus, Web of Science, the Cochrane Database of Systematic Reviews, PsycINFO, and AMED was conducted up to 31st March 2026. Systematic reviews examining the effect of BPs on OTM, root resorption, or anchorage were eligible for inclusion. Two reviewers independently performed selection, data extraction, and quality assessment using AMSTAR 2. Overlap across included reviews was assessed using a Corrected Covered Area (CCA) matrix. Within this umbrella review, animal and human evidence were synthesised separately. Results Seven systematic reviews were included, comprising one review of human patients and six reviews of animal studies, published between 2010 and 2025. The overall CCA was approximately 6.1%, indicating slight to moderate overlap. Two reviews were rated critically low and five were rated moderate on AMSTAR 2. All included reviews reported reduced OTM following BP administration. Risedronate showed the most consistent inhibitory effect in animal studies. One review conducted a meta-analysis and found BPs to be significantly more effective than osteoprotegerin in reducing mesiodistal OTM in animals. The human-focused review reported slower tooth movement and compromised outcomes in extraction cases. Evidence on root resorption was contradictory across reviews. Conclusions Available evidence, derived predominantly from animal studies, consistently indicates that BPs reduce OTM. Human evidence remains very limited and is insufficient to support firm clinical recommendations. Well-designed prospective human studies are needed to clarify the clinical implications of BP use during orthodontic treatment. Trial registration PROSPERO registration: CRD42023372111

Effect of bisphosphonates on orthodontic tooth movement: an umbrella review

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2026年7月2日

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Serena Amin,
Maria Cremona,
Stefan Abela

摘要

Background

Bisphosphonates (BPs) are potent inhibitors of bone resorption widely used to manage metabolic bone disorders including osteoporosis, Paget’s disease, and malignant bone disease. With a growing number of adult patients undergoing orthodontic treatment while receiving BP therapy, understanding the interaction between these medications and orthodontic tooth movement (OTM) is of clinical importance.

Objective

To synthesise the evidence from published systematic reviews on the effect of bisphosphonates on orthodontic tooth movement, orthodontic anchorage, and root resorption.

Materials and methods

A systematic search of MEDLINE via OVID, PubMed, EMBASE, Scopus, Web of Science, the Cochrane Database of Systematic Reviews, PsycINFO, and AMED was conducted up to 31st March 2026. Systematic reviews examining the effect of BPs on OTM, root resorption, or anchorage were eligible for inclusion. Two reviewers independently performed selection, data extraction, and quality assessment using AMSTAR 2. Overlap across included reviews was assessed using a Corrected Covered Area (CCA) matrix. Within this umbrella review, animal and human evidence were synthesised separately.

Results

Seven systematic reviews were included, comprising one review of human patients and six reviews of animal studies, published between 2010 and 2025. The overall CCA was approximately 6.1%, indicating slight to moderate overlap. Two reviews were rated critically low and five were rated moderate on AMSTAR 2. All included reviews reported reduced OTM following BP administration. Risedronate showed the most consistent inhibitory effect in animal studies. One review conducted a meta-analysis and found BPs to be significantly more effective than osteoprotegerin in reducing mesiodistal OTM in animals. The human-focused review reported slower tooth movement and compromised outcomes in extraction cases. Evidence on root resorption was contradictory across reviews.

Conclusions

Available evidence, derived predominantly from animal studies, consistently indicates that BPs reduce OTM. Human evidence remains very limited and is insufficient to support firm clinical recommendations. Well-designed prospective human studies are needed to clarify the clinical implications of BP use during orthodontic treatment.

Trial registration

PROSPERO registration: CRD42023372111