Oral and Maxillofacial Radiology
Oral implications of osteoporosis

https://doi.org/10.1016/j.tripleo.2005.04.010Get rights and content

Objectives

The association between osteoporosis and oral health remains a matter of controversy. It is important to confirm whether there is a role of osteoporosis in bone loss in the jaws, periodontal diseases, tooth loss, and other oral tissue changes. The objective of this article is to review and summarize the published literature on the associations between osteoporosis and various oral conditions such as bone loss in the jaws, periodontal diseases, and tooth loss.

Methods

A search of the computerized database MEDLINE was conducted. Clinical information concerning systemic osteoporosis and animal studies reporting possible associations between osteoporosis and changes in the dental and oral tissues were included. The review focus was on studies involving (1) methods for assessing bone mineral density (BMD); (2) methods for assessing osteoporosis-related changes in intraoral sites; (3) associations between mandibular BMD and skeletal BMD; (4) changes in the jaws, periodontal tissues, and temporomandibular joint concurrent with osteoporosis; (5) changes in the oral tissues following estrogen deficiency; and (6) effects of estrogen-hormone replacement therapy and/or calcium and vitamin D on oral health.

Results

Ninety-seven studies conducted in various parts of the world were identified. Evidence from prospective studies supports the contention that individuals with osteoporosis may be at increased risk for the manifestations of oral osteoporosis; however, such risk is not definitively proven. Studies suggest that findings on dental panoramic radiographs may be used to detect individuals with low BMD.

Conclusions

Further well-controlled studies are needed to better elucidate the inter-relationship between systemic and oral bone loss and to clarify whether dentists could usefully provide early warning for osteoporosis risk.

Section snippets

Measurement of bone density

A number of technologies can be used to assess bone density, including single photon absorptiometry (SPA), dual photon absorptiometry (DPA), dual energy X-ray absorptiometry (DXA), quantitative computed tomography (QCT), and radiographic absorptiometry (RA). The radiation doses for all techniques except QCT are low. Quantative ultrasound uses sound waves rather than ionizing radiation to assess properties of bone that are related to density and bone strength.

DXA is recognized as the best

Radiographic assessment of intraoral sites

Various tecniques have been used for assessing osteoporotic changes at intraoral sites, including SPA and DPA,7, 8, 9 DXA,10, 11, 12, 13 QCT,14, 15, 16, 17 intraoral radiographs,18, 19, 20, 21, 22 and panoramic radiographs.22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38 The majority of studies have used radiographs to assess anatomy and bone density because the costs associated with DPA, DXA, and QCT techniques, as well as access to the equipment, limit their usefulness for

Osteoporosis and its oral implications

Most studies with oral radiographic changes associated with osteoporosis have focused on measures of jawbone mass or morphology. It has been shown that mandibular BMD is correlated with skeletal bone density. Corten et al10 first suggested the use of DXA for the mandible, although their study was limited to only 4 patients. Horner et al12 were the first to carry out mandibular DXA in a clinical setting. They reported that the body of mandible may be the most appropriate site for any planned

Oral implications in the gender-related osteoporosis

Osteoporosis is more common in women than in men. Particularly, women are at greater risk for osteoporosis after menopause. Estrogen deficiency is responsible for bone loss in postmenopausal women.58 In males, hypogonadism is also clinically associated wih osteoporosis and fracture.59

Von Wowern60 has reported that the bone structure of the normal dentate jaws in older individuals is characterized by relatively thin porous cortical bone lamellae with endosteal spongiosation, as in other bones,

Oral implications of osteoporosis in the animal model

Many researchers have focused on animal models for defining the relationship between systemic and oral bone loss. Rats have constituted the most widely used animal model. An experimental study demonstrated no significant decrease in bone formation at the periosteal, endocortical, and cancellous surfaces in dentulous mandibular cross-sections between sham-operated and ovariectomized groups of aged rats.74 Tanaka et al75 indicated that estrogen deficiency in the dentulous mandibles of

Effects on oral health of medications for osteoporosis

The positive effects of estrogen-hormone replacement therapy and/or calcium and vitamin D on the postcranial skeleton are well known, however, the effects of these substances on oral bone is known less due to a lack of longitudinal studies being performed. Several studies have found that HRT has a beneficial effect on tooth loss,88, 89, 90 mandibular bone density,91 and gingival bleeding.92 Bollen et al73 did not prove any effect of hormone replacement therapy on the retention of teeth and

Conclusion

The available techniques for in vivo bone mass measurement techniques are expensive and not cost-effective to screen the general population. Recent studies have suggested that because dental panoramic radiographs are frequently made during the general practice of dentistry, the findings on such radiographs may help dentists to identify patients with undetected low BMD and refer them to medical professionals for bone densitometry.

BMD in the mandible has proven in a number of studies to be

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