Cellular and molecular mechanisms of impaired peri-implant regeneration under conditions of reduced bone mineral density: a literature review

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DOI: 10.22138/2500-0918-2026-23-3-467-484

A.A. Markov

Tyumen State Medical University, Tyumen, Russia

Abstract

This review systematizes cellular and molecular mechanisms that may impair peri-implant bone regeneration in reduced bone mineral density (BMD). Reduced BMD is considered not as a specific molecular phenotype per se, but as a potential integrated marker of pre-existing dysfunction of the regenerative bone niche. Alterations in skeletal stem and progenitor cells, bone marrow mesenchymal stromal cells (BM-MSCs), osteoblast and osteocyte lineages, RANKL/OPG-dependent osteoclastogenesis, macrophage plasticity, efferocytosis, angiogenic-osteogenic coupling, and mechanotransduction are discussed. Particular attention is paid to the concept of spatiotemporal desynchronization of repair, in which delayed resolution of inflammation and impaired restoration of the vascular niche may restrict recruitment of osteogenic progenitors, formation and mineralization of de novo bone, and subsequent mechano-adaptive remodeling. For efferocytosis, Piezo1/YAP/TAZ signaling, and CD31hiEmcnhi vessels, the limitations of direct extrapolation to peri-implant regeneration under reduced BMD are explicitly emphasized.

Keywords: osseointegration, osteopenia, osteoporosis, regenerative niche, implants, metal structures, osteoimmunology

There is no conflict of interest.

Contact information of the author responsible for correspondence

Aleksandr A. Markov
alexdoktor@inbox.ru
Received: 07.09.2026

For citation

Markov A.A. Cellular and molecular mechanisms of impaired peri-implant regeneration under conditions of reduced bone mineral density: a literature review. Vestn. Ural. Med. Akad. Nauki. = Journal of Ural Medical Academic Science. 2026, Vol. 23, no. 3, pp. 467-484. DOI: 10.22138/2500-0918-2026-23-3-467-484 (In Russ)

Funding

This study was supported by the Ministry of Health of the Russian Federation as part of the state assignment (AMRU-2025-0005).

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