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About osteoporosis

Osteoporosis is a skeletal disorder characterized by a progressive loss of bone mass and deterioration of bone tissue. Osteoporosis is diagnosed by measuring bone mineral density (BMD) in various parts of the body. When BMD is low, it means that your bone tissue has weakened, making your bones fragile and increasing your risk for fractures.¹

An estimated 10 million US adults have osteoporosis. Another 43 million have low bone mass.² More than 80% of those diagnosed with osteoporosis are women, 25% of whom are over age 65. Levels of the hormone estrogen drop dramatically after menopause.³ This can directly contribute to the development of osteoporosis as estrogen plays a key role in building bones.

The risk of developing osteoporosis is higher if you do not develop strong bones from an early age. If this happens, you will have less bone mass to draw on in later years.³ For example, by the age of 18, girls have generally developed 90% of their bone mass. Eating disorders, poor nutrition, lack of physical activity, or other health problems early in life can prevent proper bone development.

Other risk factors for the development of osteoporosis include:¹

• Small, thinner, or less dense bones, which are more typical in women.
• A longer life span in women.
• Low body weight.
• Poor health and low physical activity.
• Gastrointestinal disorders, including celiac disease.
• Low calcium intake.
• Alcohol and tobacco use.
• Heart or thyroid disease.
• Bone cancer patients are at an increased risk for bone loss and skeletal fractures due to the direct effects of cancer and the side effects of certain cancer treatments.

Osteoporosis often goes undiagnosed until it is more advanced. Once bones begin to deteriorate, they can be protected through an active lifestyle, medication, and treatment. They cannot be restored to their original strength. This is why early detection and treatment intervention is crucial.

Osteoporosis and your oral health

Osteoporosis can have a significant impact on your oral health. For example:

• Low BMD and periodontal disease become more prevalent as you age. In fact, a recent study revealed that 40% of adults over age 40 who have been diagnosed with osteoporosis also had periodontal disease. This may not be a coincidence. Research has begun to suggest that there may be an association between the two conditions.⁴
• Lower BMD may leave the jaw bone more susceptible to bacteria. This may explain why many individuals with osteoporosis have more severe symptoms of periodontal disease.¹
• Osteoporosis can intensify headaches and ear, jaw, and neck pain in people with TMJ disorders.¹
• Women with osteoporosis are three times more likely to experience tooth loss than those who do not have the disease.¹
• Low BMD in jawbones can cause loose or ill-fitting dentures and poor oral surgery results.¹

Dentists can play an important role in screening for initial signs of osteoporosis. In fact, your dentist may be your first healthcare provider to suspect osteoporosis could be a contributing factor to your oral health symptoms. This makes regular dental visits all the more important. Researchers have found that dental X-ray images, particularly panoramic X-ray images, were highly effective in the early identification of osteoporosis. If your dentist suspects low bone density may be causing some of your symptoms, they may refer you to a doctor for further tests.⁵

Inform your dentist:

• Don't wait until you are diagnosed with osteoporosis to address your oral health. The effects of and treatment for osteoporosis can complicate dental treatment. For example, you may need to complete any necessary dental treatment involving bone (e.g., extractions, bone grafting, or dental implants) before you start taking oral or intravenous bisphosphonates, a class of drugs used to treat osteoporosis. This type of medication can have severe implications for your jawbones if dental treatment is performed after you have begun to take it. You can find more information in the "Other considerations" section below.
• Inform your dentist or hygienist that you have been diagnosed with osteoporosis when they conduct a health history and current health status. Also, inform them if you have any other common risk factors, such as being post-menopausal, a history of fractures, a low activity level, or any other systemic diseases you have. You should also mention any supplements or natural remedies you currently take or plan on taking.
• Be sure to provide your dentist and physician(s) with each other's contact information. This is important if they need to discuss your disease, oral health status, and medications you take.
• Let your dentist know if you've noticed any of the symptoms of periodontal disease or other peculiar issues in your mouth, such as rashes, swollen gums, sores, or dentures that no longer fit properly.

Make oral health a priority: You should practice a lifetime of good oral hygiene, visit your dentist regularly, reduce your risk factors, and address any issues as soon as they occur.

• Make sure you are brushing at least twice a day with a soft-bristled brush and fluoride toothpaste. If you have symptoms of dry mouth, specially labeled toothpaste or gel are available to help reduce these symptoms. If your gums bleed, don't stop brushing your teeth. Bleeding gums may be a sign of inflammation or plaque build-up below your gum line, which requires more attention, not less.
• Flossing at least once a day helps remove plaque from between teeth where brushes do not reach.
• If your dentist feels that you are not getting enough fluoride from your water sources, they may suggest fluoride supplements.
• To prevent and treat tooth decay, gingivitis, and periodontal disease, visit your dentist regularly for exams and professional teeth cleanings on the schedule your dentist recommends. As your osteoporosis advances, your dentist may suggest more frequent visits, especially if you are taking certain medications.
• Let your dentist know if you have any loose teeth. Loose or missing teeth can have profound effects on your oral health.
• You and your dentist should let your doctor know about any treatment your dentist recommends. Ask your doctor if any of the medications you are or may be taking have side effects, such as dry mouth, which is a significant risk factor for the development of tooth decay. If a tooth develops significant decay and needs to be removed, it can present serious problems if you are taking bisphosphonates for the treatment of osteoporosis.
• Eat a well-balanced diet rich in calcium and vitamin D, which work together to build strong bones. Your doctor may also suggest you take supplements. One study found taking calcium and vitamin D supplements showed significantly increased bone density after three months and also had a positive effect on periodontal health.⁶

Estrogen replacement therapy: Estrogen replacement therapy (ERT) has been a common osteoporosis treatment for decades. Studies have shown that it slows BMD loss and has a positive effect on jaw bone density, alveolar resorption, and tooth loss.¹ Studies also show that longer-term use of ERT lowers the risk of edentulism by up to 50%.⁷

Medications: A class of drugs known as bisphosphonates is often prescribed to treat osteoporosis. They are also used to treat certain types of cancer which involve bone. Bisphosphonates can impact your oral health in a couple of important ways:

• Bisphosphonates may reduce blood circulation to bones, particularly in the head and neck. Reduced circulation slows the ability for healing and immune cells to reach dental procedure sites such as extractions, bone grafts, or implants. This can result in poor wound healing and an increased chance of infection.
• A severe side effect of bisphosphonate treatment called "osteonecrosis of the jaw" (ONJ) can lead to increasing pain, loss of bone function, and progressive jaw bone destruction. ONJ is very rare. While it has occurred in people with osteoporosis, it typically affects individuals who have cancer that has spread to their bones and are being treated with intravenous (IV) forms of these drugs.

Because of these risks, it may be in your best interest to have necessary dental treatment, especially invasive procedures involving bone, completed before beginning osteoporosis treatment. An alternative is to delay dental treatment until your dentist and doctor agree that it is safe to do so. When infection, pain, and swelling are involved, this may not be an option.

This is why it is so important for people with osteoporosis to maintain good dental health and do their best to avoid problems altogether.