OSTEOPOROSIS AND ORAL BONE LOSS PREVENTION
by Seymour L. Gottlieb, BS, BDS, DDS, member of NOHA's Professional Advisory
Board, retired from a private practice in Dentistry in Northbrook, Illinois;
former Research Assistant and Instructor, College of Dentistry, University of
Illinois and Researcher in Microbiology, United States Public Health Service,
Center for Disease Control.
Osteoporosis is the most common metabolic bone disease in the United States.
Over ten million people have osteoporosis, eighty percent being women. Another
eighteen million are at risk due to having a low level of calcium and phosphorus
minerals in their bones. Five million are men who have either low bone density
or outright osteoporosis. The National Institutes of Health has just embarked
upon a seven-year study, coordinated at seven universities to study bone mass
and risk factors in men.
Osteoporosis is a systemic skeletal disease characterized by a reduced amount
of calcium and phosphorus in bone causing reduced strength and impairment of
bone formation and reduced strength. It can occur at all ages and in all
populations. An average adult has about 2.2 pounds (1000 grams) of calcium. We
lose calcium through sweat, urine, feces, and bone remodeling. Bone is a living
tissue made up of an inner and outer layer of bone and a bone marrow core, which
produces blood cells. It is made up of calcium, phosphorus, and other minerals
with nerves and blood vessels running through it. Bone functions to support the
weight of the body as well as to store calcium and phosphorus. Bones and teeth
hold about ninety-nine percent of the body’s calcium. The remaining one
percent circulates in the blood. When the calcium level in the blood drops, bone
remodels releasing more calcium to maintain a balance of minerals in the blood.
Five to ten percent of the calcium in our bones is replaced (remodeled)
annually. None can ever be removed from the teeth.
Osteoporosis is the most common metabolic bone disease in the United
States. Over ten million people have osteoporosis, eighty percent being women.
Another eighteen million are at risk due to having a low level of calcium and
phosphorus minerals in their bones.
During childhood, bone is built up more rapidly than it is broken down. In
the late twenties, this process becomes nearly balanced. By the mid-thirties,
women lose more bone mass at a rate of about one-half percent a year until
menopause. Women lose one to five percent of their bone mass annually during the
first few years of menopause and then lose it more slowly.
Women are at a higher risk after menopause because they stop producing
estrogen, which retards bone loss. One out of four after menopause and ninety
percent of women over seventy-five have osteoporosis. An increase in prevalence
of osteoporosis correlates with increasing life span. Osteoporosis occurs when
bones lose more of their bone mass than is formed and then become brittle. The
main complication of osteoporosis is bone fractures. Osteoporosis
is responsible for 1.3 million fractures in the United States annually. Fourteen
percent of fifty-year-old white females are expected to have hip fractures in
their lifetime. For every five years increase in age after sixty-five, there is
a forty percent increase in the risk of hip fracture. Fracture complications
kill as many women each year as does breast cancer.
Genetic and systemic factors are strong influences in the development of
osteoporosis as are nutrition, environment and lifestyles. While there is no
cure, early preventive measures can prevent or substantially reduce its impact.
The National Institutes of Health 2000 Osteoporosis Conference reported that low
estrogen levels, high dietary protein, plus caffeine, phosphorus, sodium, and
smoking all adversely affect the calcium balance. Low levels of vitamin D and
calcium are common in aging populations. Exercise reduces by twenty-five percent
the risk of osteoporosis.
Osteoporosis is responsible for 1.3 million fractures in the United
States annually. Fourteen percent of fifty-year-old white females are expected
to have hip fractures in their lifetime. . . . Fracture complications kill as
many women each year as does breast cancer.
Bone loss in the oral cavity is also a significant problem with age. As much
as ninety four percent of United States women over sixty-five have dental bone
loss. Both osteoporosis and oral bone loss are asymptomatic and diagnosis
usually is made after a problem exists. Both result in significant bone loss in
middle-aged or older persons. At the cellular level, these two diseases have
many of the same pathological mechanisms that cause bone resorption.
Dentists are often asked:
(1) Does osteoporosis affect the upper and lower jaw?
(2) How is the progress of periodontal disease affected when a person has
(3) What preventive and treatment strategies would be beneficial to maximize
oral bone health and limit osteoporosis?
(1) Findings pertaining to the upper and lower jaws:_two_aspects_will be
Bone of the jaw where teeth are missing (residual ridge)
The relationship between osteoporosis and the jaws’ residual ridge was
first observed in 1990. Researchers correlated the severity of osteoporosis with
the degree of residual ridge resorption. In 1993, another study of patients with
all teeth missing further confirmed that oral oral bone loss correlates with
skeletal bone mass. Osteoporotic people lose more teeth than similarly matched
non-osteoporotic people. A very recent study demonstrated that the upper jaw is
composed of bone structure that is more susceptible than the lower jaw. Bone
changes in the jaws parallel changes found in other bones in normal aging.
Bone that surrounds and supports teethThis is the only place where
periodontal disease can occur. The initiation of periodontal disease does not
depend on the general mineral density of the other bones in the body. Bone loss
immediately around the teeth is primarily caused by local factors not present
elsewhere in the body. These include bacterial plaque, calculus [mineral
deposits on teeth], appliances worn, trauma, and home care.
(2) Osteoporosis and dental diseases
Osteoporosis does not cause gingivitis (inflammation of the gums) or tooth
mobility. However, one report states that individuals with osteoporosis, heavy
calculus formation, and severe periodontal disease do have more tooth support
loss than similar non-osteoporotic patients. Another study states that women
with high bone mineral values retain teeth with deep periodontal recession
pockets longer than women with low mineral density (osteoporosis).
(3) Preventive treatment
Osteoporosis is preventable and not an inevitable consequence of aging. We
can start protecting our bones immediately with healthy habits. One must combine
dietary and lifestyle changes. In exercise, muscle pressure stimulates the bones
to absorb calcium and grow stronger. Americans spend a smaller percent of their
income on food than any other nation on earth. according to Healthy People
2001, Forty percent of a family’s food budget is now spent in restaurants
or on carry-out meals. Such foods are generally higher in fat and sodium and
lower in calcium and fiber. Fast food chains market their products in public
schools through lunchroom franchises, teaching materials, and advertising
contracts. Beverage companies have contracts with school districts and
universities amounting to hundreds of millions of dollars per year. In Kansas
City, schools negotiated contracts paying twenty-seven dollars per student per
year. The average American drinks fifty-six gallons of soda a year, which is
equivalent to six hundred twelve-ounce cans. Each sugar-sweetened can contains
ten teaspoons of sugar providing empty calories while replacing more nutritious
drinks. Excess soda consumption increases phosphorus intake, which adds to a
calcium deficiency by affecting the body’s desired calcium-to-phosphorus
In addition, the United States Census Bureau estimates that thirty-one
million Americans don’t know if they will have enough groceries to last the
month. Food stamp benefits in the United States average seventy-one dollars per
month for each person, allowing only eighty cents per person per meal.
The average American drinks fifty-six gallons of soda a year, which is
equivalent to six hundred twelve-ounce cans. Each sugar-sweetened can contains
ten teaspoons of sugar providing empty calories while replacing more
The benefits of calcium supplementation begin to fade in one to two years
after you stop taking them unless calcium foods in your diet are equivalent. To
maintain bone density, calcium and its related bone-building minerals must be
taken indefinitely. Magnesium is very important in influencing mineral
metabolism directly or through its effect on hormones. Inadequate magnesium
intake can limit bone growth and increase bone fragility. Calcium
supplementation without magnesium may result in greater demineralization
activity. An ideal range for a ratio of intake for the two minerals is two parts
calcium to one part magnesium or, in some cases, a one-to-one ratio.
The National Academy of Sciences in 1997 suggested 1000 milligrams (mg) each
day of calcium intake for men and women over twenty-five years-of-age increasing
to 1200 mg over age fifty-one and for teenage girls. Others recommend 1500-1800
mg. each day for the latter group and lactating women. Other important nutrients
that aid calcium deposition and bone formation are:
500-800 mg each day
600 mg (equals one banana)
10-20 mg (inhibits bone loss and is needed for cell growth.)
400-600 international units
Omega-3 fatty acids
1000 mg (aids prostaglandin production that stimulates calcium
deposition by the bone cells.)
Food sources of calcium for the vegan include:
Estimated calcium in mg
Rice or soy milk
A New England Journal of Medicine study reported a forty-three percent
reduction in bone loss in postmenopausal women who supplemented regular diets
with 1000 mgs of calcium for two years. Intestinal absorption of calcium
declines with age in both sexes. Low gastric acid, large quantities of fiber,
medications, diuretics, or alcohol can interfere with calcium absorption. A
three-ounce portion of meat provides about twenty milligrams of protein. A diet
excessive in protein can also be detrimental to bone. To digest protein, acids
are released into the blood stream. To neutralize these acids, the body must
remove calcium from the bone. Women are recommended to have forty-five to
fifty-five grams of protein a day and fifty-five to sixty-five grams for men.
Osteoporosis is a risk factor for oral bone loss. Bone density changes in the
jaw parallel changes found in other bones in normal aging. Skeletal bone density
is related to jaw bone loss especially in postmenopausal women. No association
was observed in women with low or intermediate amounts of calculus. No
relationship of osteoporosis with the etiology of periodontal disease has been
found. Professional along with personal home care is most effective in
controlling periodontal disease in both osteoporotic and non-osteoporotic
All factors that optimize bone health must be included at all times. Simply
ingesting calcium and vitamin D will not reduce your risk. Having a bone mineral
density test can help you determine your status.
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Article from NOHA NEWS, Vol. XXVI, No. 4, Fall 2001, page 4.
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