Strontium-Loaded Titanium and Systemic Teriparatide Synergistically Enhance Osteogenesis and Osseointegration in an Osteoporotic Rabbit Model

Poor osseointegration of Titanium (Ti) implants in osteoporotic bone can lead to early construct failure in clinical settings. This study investigated whether combining Strontium (Sr) surface loading (modified alkali and heat treatment) with systemic teriparatide administration could enhance implant osseointegration in osteoporotic conditions. Mouse osteoblast-like cells (MC3T3-E1) were cultured on Sr-loaded Ti surfaces with and without teriparatide administration to evaluate cell adhesion, proliferation, differentiation, and mineralization capacity. This in vivo study utilized an osteoporotic rabbit femur through ovariectomy and steroid administration. The combined treatment (Sr-loaded Ti and teriparatide) enhanced osteoblast differentiation and mineralization in vitro, with an increase in alkaline phosphatase activity and alizarin red staining. Six and twelve weeks after in vivo implantation, the combination therapy demonstrated superior outcomes compared to the single treatments (Sr-loaded Ti or teriparatide), including enhanced bone–implant interfacial strength, improved bone morphology parameters, higher mineral apposition rates, and greater bone–implant contact. These findings demonstrate that the synergistic approach of Sr-loaded Ti implants combined with systemic teriparatide administration considerably improves implant osseointegration in osteoporotic bone, suggesting a promising strategy for enhancing implant outcomes in patients with osteoporotic bone quality.