Osteoporosis and periodontitis: discussion, conclusions, and recommendations.

Abstract

1). Osteopenia is a condition of compromised bone strength that predisposes an individual to a risk of fracture. The paper accompanying this discussion by Dr. Charles Chesnut elegantly underscores that bone fragility has 2 components: bone density and bone quality.2 The density of the bone is extensively monitored in osteoporotic conditions, with dual energy xray absorptiometry being the gold standard; however, a reliable standard to measure bone quality has not been established. The line between osteoporosis and osteopenia has largely been a statistical one defined by the World Health Organization as 2.5 standard deviations below the mean for young white women. This is similar to determining a diagnosis of periodontitis solely on the presence of a site with 5 mm of attachment loss. Clearly a standard like this makes categorizing patients easier but provides little information on who needs treatment or preventive intervention. Moreover, can the standard be generalized to other ethic groups, men, or children? For these reasons, both osteoporotic and periodontal diseases are often clinically diagnosed and treatment sequenced on the basis of risk indicators for disease. In a comparison of the risk factors associated with osteoporosis and periodontal diseases, illustrated in the accompanying paper by Dr. Jean WactawskiWende, it seems clear that there are multiple similarities between the 2 disease processes.3 The diseases are associated in general with advancing age, with the vast majority of patients being over the age of 35, and a higher incidence in the later decades. A patient with a history of loss of alveolar bone support is at risk for future progression of periodontitis. Likewise, a patient with systemic bone loss or osteoporosis is at risk for osteoporosis. A history of previous bone loss is a common risk indicator for both periodontitis and osteoporosis. Systemic disease and certain medications (such as chronic corticosteroids) may worsen both periodontitis and osteoporosis. Smoking seems to be a significant risk indicator for severity and a risk factor for progression in both conditions. In addition, the pathophysiology of both diseases appears to have a hereditary or, at least, familial component. HEALTH CONSEQUENCES OF OSTEOPOROSIS Osteoporosis was once thought of as a natural part of the aging process in women, much the same way that tooth loss was thought to be related to age rather than chronic periodontal infection. Today, osteoporosis is no longer considered age or gender dependent. Approximately 10 million people in the United States have osteoporosis and almost twice that number have low bone mass or osteopenia. Currently, a patient experiencing a hip fracture has a 1 in 6 likelihood of mortality, a 1 in 5 likelihood of being non-ambulatory, and a 1 in 3 likelihood of needing dependent care. The estimated cost of osteoporosis fractures annually is $20 billion, not including subsequent complications of pressure sores, pneumonia, urinary tract infections, and depression.1 If one considers the rapidly expanding population group older than 65 years of age, the impact of osteoporosis on health care becomes readily apparent. In the year 2000, the world population had approximately 350 million people over the age of 65; by the year 2050, it is estimated that 1.5 billion people will be older than 65 years of age.1 The impact of this aging population will have dramatic effects on the number of fractures related to osteoporosis. In 2000, there were approximately 1.7 million fractures related to osteoporosis in adults 35 years of age or older. The number of osteoporotic fractures, in the same age group, is projected to reach 6.2 million by 2050.1 Without intervention or a better understanding of the disease process, this will have a devastating result on the health care system. Whether this potential progression in osteoporosis will have an equal effect on oral bone loss may require a better understanding of the interrelationship between osteoporosis and periodontitis.