Consequence of Bisphosphonate Use on Dental Implant Removal in Osteoporotic Patient: A Nationwide Cohort Study

Introduction: This nationwide population-based cohort study aimed to investigate the relationship between bisphosphonate (BP) use and dental implant removal in patients with osteoporosis. Methods: A total of 389 226 individuals aged ≥ 65 years with osteoporosis who underwent dental implant surgery between 2014 and 2018 were included. Patients were classified into BP and control groups based on their prescription records. Implant removal was identified using the procedural codes from 2019 to 2020. Multivariate logistic regression analysis was performed to examine the association between BP and implant removal. Subgroup analyses evaluated the impact of the BP administration route (oral vs. intravenous), BP type, and cumulative defined daily dose (DDD) on the risk of implant removal. Results: The BP group demonstrated a modestly increased risk of implant removal compared to the control group (adjusted odds ratio [OR]: 1.09; 95% confidence interval [CI]: 1.05–1.15). Participants with periodontitis had a significantly higher risk of implant removal than participants without periodontitis (adjusted OR: 1.87; 95% CI: 1.63–2.15). Among BP users, the subgroup analysis revealed that intravenous BP administration was associated with a lower risk of implant removal than oral administration (adjusted OR: 0.87; 95% CI: 0.80–0.94). In addition, the risk of implant removal increased progressively with higher cumulative DDDs, highlighting the importance of total BP exposure. Conclusion: This study underscores the critical role of cumulative BP exposure in the risk of implant removal, which challenges conventional assumptions regarding administration routes. Future research should explore strategies to optimize implant outcomes in patients with osteoporosis.