Osteoporosis

Osteoporosis is frequently referred to as “the silent disease” as it oftentimes progresses slowly without symptoms. The disease is characterized by porous bone, leaving them more fragile and susceptible to fracture. Osteoporosis affects 44 million Americans; 10 million have the disease and another 34 million are at high risk due to low bone density.29 Osteoporosis is responsible for 1.5 million fractures annually, primarily in the hip, spine and wrist.30 The risk of an osteoporotic fracture for women over the age of 50 is 50 percent, which is equivalent to the combined risk of developing breast, uterine and ovarian cancers.29-30

The consequences can be severe with a 10-20 percent increase in mortality rates occurring after hip fractures.30

Figure 5: Osteoporosis in Women

Risk Factors, Prevention & Treatment

Females are at greater risk than men for developing osteoporosis. The risk increases for both genders with age. Other risk factors include low bone mass, family history, amenorrhea, estrogen deficiency, cigarette smoking, use of certain medications and Caucasian or Asian ethnicity.

Osteoporosis cannot be cured, but it can be prevented and treated. Prevention is critical before age 20 when most skeletal mass forms. Preventative steps include a diet rich in calcium and vitamins D and K, weight-bearing exercise, avoiding smoking or excessive alcohol, a consultation with healthcare professionals about bone density and early screening. In 2004, the Nurses Health Study reported that women who walked for at least four hours weekly had a 40 percent reduction in the risk of hip fractures.31 Once diagnosed, treatments for osteoporosis may include oral bisphosphonates (Actonel, Fosamax, Boniva); intravenous bisphosphonates (Zometa, Aredia) for severe cases; Calcitonin, an FDA approved injectable and nasal spray; and Selective Estrogen Receptor Modulators (Evista) or Hormone Replacement Therapies (HRT). There have been controversial theories around the use of HRTs resulting in physicians prescribing treatment with HRT on an individual needs basis.32

Oral Connections

Research shows bone loss due to periodontal disease may progress more quickly in patients with osteoporosis33 since the mandible is susceptible to accelerated alveolar bone resorption. Dental professionals should pay particular attention to rapid bone loss, periodontal attachment levels and/or tooth mobility in post-menopausal women who are at increased risk for osteoporosis. An area of much discussion and confusion recently has been the treatment of dental patients who are taking bisphosphonates. Several organizations, including the American Dental Association and the National Osteoporosis Foundation, have issued guidelines to use as a resource that differentiate between intravenous and oral bisphosphonates.34,35