Osteoporosis And Periodontitis

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Osteoporosis and periodontitis are the diseases that affect a large number of men and women worldwide with incidence increasing with advancing age. Both these diseases present bone loss as a common hallmark. Periodontitis has long been defined as an infection mediated destruction of the alveolar bone and soft tissue attachment to the tooth, responsible for most tooth loss in adult populations. Systemic loss of bone density in osteoporosis including that of the oral cavity may provide a host system that is increasingly susceptible to infectious destruction of periodontal tissue. Understanding the association between these common diseases and the mechanisms underlying these associations will aid health professionals to provide improved means to prevent, diagnose and treat these very common diseases. The paper reviews the current evidence on the association between periodontal disease and osteoporosis.


Osteoporosis is a skeletal disease characterized by reduction in bone mass and micro architectural changes in the bone, which leads to an increased bone fragility and an increased risk of fracture [1]. Osteoporosis results from an imbalance between the rate of bone formation and resorption that leads to loss of bone mineral mass. Loss of the mineral component of the bone leads to a greater tendency of the bone to be broken. The consequences of fracture in elderly people include an increased risk of death, long-term nursing home care or permanent limitations in mobility and performance of daily living activities. Many of the risk factors for osteoporosis are environmental and therefore, are preventable. Established risk factors include older age; female gender; post menopause; Caucasian or Asian race; a low body mass index; cigarette use; alcoholism; inadequate calcium and vitamin D intakes; physical inactivity; taking medications such as glucocorticoids and anticonvulsants; and anorexia nervosa [2,3]. Although osteoporosis and osteopenia can affect people of all ages, they occur most often in middle aged and elderly people [4].Osteoporosis is categorized into primary or secondary. Primary osteoporosis is associated with increased age and/or decreased sex hormones. Secondary osteoporosis implies an underlying cause such as usage of glucocorticoids, systemic diseases


Basically, interpretation of results from these studies is complicated by the variety of methods used to assess osteoporosis and periodontitis, as well as varying definitions of outcomes of intere st. If osteoporosis is a predisposing factor for periodontal tissue destruction, then arelationship should exist between measures of systemic bone mineral density and periodontal tissue destruction.However, previous studies have failed to establish a strong relationship. Possible explanations for this could be lack of precise methods for assessment of bone density and confounding of the result by other factors such as age, gender, smoking, remaining nature teeth, hor-mone intake, exercise of jaw bone, and most importantly the host susceptibility to dental plaque and oral hygiene status. Moreover, the cross-sectional studies have their own limitations, since little information is available about the pattern of disease progression during the short period of the study, nevertheless, most osteoporosis and periodontal disease progress in a chronic pattern.

Although findings of these studies regarding the association between osteoporosis and periodontal disease are still controversial, with Increases in the number of aged patients in Tai wan society, the dialogue among medical and dental professional in this field provides a unique viewpoint in achieving and maintaining patients’optimal health. Clearer understanding of this relation-ship may aid health care providers in their efforts to detect and prevent osteoporosis and periodontal disease.(27). POTENTIAL MECHANISM OF ASSOCIATION Several potential mechanisms Mechanism by which osteoporosis or systemic bone loss may be associated with periodontal attachment loss, loss of alveolar bone height and tooth loss have been proposed(28)

1) Low bone density in the oral bone associated with low systemic bone: This low bone density or loss of bone density may lead to more rapid resorption of alveolar bone following insult by periodontal bacteria. 2) Modification of local tissue response to periodontal infections due to systemic factors affecting the bone remodeling: Persons with systemic bone loss are known to have increased systemic production of cytokines (IL 1 and 6) that may have effect on the bone throughout the body including bone of oral cavity . Periodontal infections have been shown to increase local cytokine production that in turn increases local osteoclasts activity resulting in increased bone resorption. 3) Genetic factors that predispose a person to systemic bone loss: These also influence or predispose an individual to periodontal destruction.

4) Environmental factors such as cigarette smoking and sub optimal calcium intake, among others, may put individuals at risk for development of both osteopenia and periodontal disease. However, most of the studies consider low systemic bone density as the primary factor for the rapid resorption of alveolar bone. Studies have attempted to define the relationship between osteoporosis and periodontitis. Most studies support a positive association between these common diseases and inspite of the various limitations, recent investigations have been designed to provide more specific information. Groen etal (1968)(29) assessed the relationship between osteoporosis or low bone density and clinical attachment levels. Toothlessness and severe periodontal disease were found among 38 patients, aged 43 to 73, who exhibited clinical and radiographic signs of advanced osteoporosis.

Philips and Ashley (1973)(30) found that bone density assessed by the metacarpal index (MI) was associated with mesial probing depth (Russell’ s periodontal index) and was significantly associated when limiting the assessment to posterior teeth, in 113 females, aged 30-40 years. Ward and Manson (1973)(31) were able to find an association between the periodontal disease index and alveo1ar bone loss, but no relation between metacarpal index and periodontal index was found. Elders et al (1992)(32)assessed the association between alveolar boneheight and, spinal BMD and Metacarpal Cortical Thickness (MCT) in 286 women, aged 46-55 years, 21% of whom were edentulous. The dentate subjects, mean alveolar bone height was significantly

correlated with spinal BMD, MCT, age and years since menopause. However, lumbar BMD and MCT were not found to significantly correlated with alveolar bone height. The fact that no association was detected, may be due to the selection of subjects, given their relatively young age (46-55 years) when prevalence of osteoporosis may be low , limiting the association that may be observed.
Ward and Manson (1973)(31,32) were unable to show a significant relationship between alveolar bone loss and bone density of hand using metacarpal bone index. However, rapidity (a measure of alveolar bone loss divided by age) was found to be associated with metacarpal bone index in females but not males, potentially suggesting some role of osteoporosis in loss of oral bone by gender and with ageing.

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Osteoporosis And Periodontitis