Osteoporosis And Oral Health Closely Linked, UB Analysis of National Database Shows

PHILADELPHIA, Pa. -- Women with osteoporosis are at high risk of developing gum disease and losing their teeth, the first large-scale assessment of the relationship between bone metabolism and oral health has shown.

Researchers at the University at Buffalo led by Jean Wactawski-Wende, Ph.D., compared bone-mineral density and two measures of oral health in 2,599 postmenopausal women who participated in the National Health and Nutrition Examination Survey III (NHANES), conducted between 1988 and 1994.

Their analysis showed a strong and direct relationship between bone loss, gum- attachment loss (an indicator of periodontitis, or gum disease) and tooth loss.

Results of the analysis were presented here today (Monday, Feb. 16) at a symposium devoted to integrative biomedicine at the annual meeting of the American Association for the Advancement of Science. The symposium was chaired by Robert J. Genco, D.D.S., Ph.D., professor and chair of the UB Department of Oral Biology.

"Women whose bone-mineral density was two standard deviations from the norm, representing the loss of roughly 200 milligrams of bone, increased their risk of having periodontal disease by 86 percent," Wactawski-Wende reported. "I think we can say also that people diagnosed with periodontal disease may be at higher risk of underlying osteoporosis.

"It is still early in the study of this relationship, but it looks like we've bridged the gap between these two diseases," she said. "If the relationship remains strong in further studies, it's possible something as simple as a routine dental X-ray could be used to screen for bone loss. Dentists could employ interventions available for preventing and treating osteoporosis to combat oral bone and tooth loss."

Both osteoporosis and periodontal disease are serious public-health concerns. Osteoporosis affects more than 20 million people in the U.S., most of whom are women, and results in nearly 2 million fractures per year. Total costs of this disease, including lost activity and indirect factors, is estimated to reach $18 billion in the U.S.

Some form of periodontal disease affects 75 percent of the U.S. population, with 30 percent of older adults experiencing severe disease.

The NHANES analysis was based on measurements of bone-mineral density of the hip, using dual-energy X-ray absorptiometry (DXA); attachment loss, defined as the depth of the pocket between tooth and gum, and number of missing teeth.

Results showed an 86 percent increase in attachment loss and a 32 percent increase in tooth loss for every 2/10 of a gram decrease in bone-mineral density. These results support those of a pilot study of 70 postmenopausal women Wactawski-Wende conducted in 1995. That study appeared in the Journal of Periodontology.

Wactawski-Wende said it is thought that the loss of mineral content makes bone more susceptible to periodontal bacteria, which then increases gum detachment and the risk of tooth loss.

Strong associations with both attachment loss and tooth loss also were found with smoking, lower educational level, increasing age and increasing body-mass index. In addition, findings indicated African-American women were more than two times more likely to have attachment loss than white women, and Mexican-American women were five time less likely to have tooth loss than white women.

Wactawski-Wende is co-principal investigator on a four-year study, funded by the U.S. Army's medical unit, to more clearly define the relationship between oral health and osteoporosis.

The study involves 1,300 women enrolled in the Women's Health Initiative Vanguard Center at UB. Oral health will be assessed using attachment loss, tooth loss, alveolar-crestal bone height (bone to which the teeth are attached) and jaw-bone density. DXA measurements will be taken of the hip, spine, forearm and whole body, as well as the mandible.

"The results of this study will be available in the year 2000," she said. "At that point, we should have a much clearer understanding of the relationship between these diseases."

Additional researchers on the NHANES analysis, all from the University at Buffalo, were Genco; Sara G. Grossi, D.D.S.; Ernest Hausmann, D.D.M.; Maurizio Trevisan, M.D.; Mieko Nishida; Robert Dunford, and Alex Ho.