Bisphosphonate Exposure and Risk of Postoperative Complications Following Orthognathic Surgery
Lindsay Park, Ashish Nalla, Isaac Mordukhovich, Bahar Bassiri Gharb, Antonio RampazzoBackground:
Bisphosphonates are widely prescribed for osteoporosis and metastatic bone disease due to their effects on bone remodeling. However, prolonged suppression of osteoclast-mediated bone resorption, combined with direct effects on oral soft tissue, angiogenesis, and immune function raises concern for impaired healing in the maxillary and mandibular bones. Existing literature is limited to small case series primarily focused on osteonecrosis of the jaw, with minimal evaluation of broader postoperative infectious and inflammatory outcomes.
Methods:
We retrospectively evaluated complications following orthognathic surgery in patients with prior bisphosphonate exposure using the TriNetX database. Adults (≥18 years) who underwent Le Fort I osteotomy, mandibular osteotomy, or genioplasty between 01/2005 and 01/2026 were stratified by bisphosphonate exposure within 10 years preceding surgery (n = 108) versus no exposure (n = 20 958). Postoperative complications included osteonecrosis of jaw due to drugs, infection, inflammatory conditions, alveolitis, cellulitis and abscess of mouth, cellulitis of face, and infection and inflammatory reaction due to internal fixation of device.
Results:
After propensity score matching (n = 107), complication rates were significantly higher among bisphosphonate users compared with non-users (31.78% vs 18.69%), corresponding to a risk ratio of 1.70 (95% CI: 1.05-2.76). Kaplan–Meier analysis did not demonstrate significantly lower complication-free survival in the bisphosphonate cohort (59.91% vs 79.47%; log-rank
Conclusions:
These findings suggest that prior bisphosphonate exposure may be an important factor to consider during perioperative risk assessment and counseling for patients undergoing orthognathic surgery.