Osteoporosis versus Tooth Loss

Samin Sirous1*, Iraj Salehi-Abari2

1Internship of Dentistry in Islamic Azad University, Khorasgan Branch, Isfahan, IRAN.
2Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, IRAN.

Osteoporosis is a common metabolic disease of the bones that increases bone fragility due to decreased bone mass and bad quality of bone, leading to an increased risk of bone fracture. This disease affects all the bones, including femurs/pelvis, spine, forearms, ribs, mandible, and maxillary bone. Periodontitis is an inflammation of the tissue around the teeth that results from infections and leads to tooth loss due to attachment loss and destruction of the alveolar bones around the teeth. Apart from Periodontitis, does Osteoporosis also lead to tooth loss? The purpose of this article is to answer this question. An electronic search of English language literature was conducted through PubMed, Medline, and Google scholar. The articles were selected through their topics and contents regarding osteoporosis, periodontitis, and tooth loss. The selected articles included cross-sectional, cohort, and review studies. Osteoporosis and periodontitis are multifactorial diseases and recent studies revealed a positive relation between periodontal disease and osteoporosis. In summary, as well as osteoporosis has an indirect correlation with tooth loss by periodontitis, it also has a direct relationship with tooth loss by decreasing mandibular and maxillary alveolar bone density. Not only Tooth loss could occur due to periodontitis, but also it has many other reasons, which with nowadays researches osteoporosis counts as one of them. Due to the effect of osteoporosis in the reduction of BMD and its relationship with periodontitis, it can both directly and indirectly result in tooth loss. Further well-controlled researches are required to clarify the inter-relationship between osteoporosis and tooth loss.

Keywords: Osteoporosis; Tooth loss; Periodontitis; BMD

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How to cite this article:
Samin Sirous, Iraj Salehi-Abari. Osteoporosis versus Tooth Loss. American Journal of Orthopedic Research and Reviews, 2020; 3:16. DOI: 10.28933/ajorr-2020-10-2705


1. Iraj Salehi-Abari, Shabnam Khazaeli, Ali Niksirat. The Tsunami of Osteoporosis Will Be Coming. Open Science Journal of Clinical Medicine. Vol. 3, No. 4, 2015, pp. 153-155.
2. Salehi‐Abari I. Early diagnosis of osteo-penia/osteoporosis by bone mineral density test using DXA method in early adulthood—a pre‐emptive step towards future bone health. Interna-tional journal of rheumatic diseases. 2017 Jan; 20(1):122-5.
3. Darcey J, Horner K, Walsh T, Southern H, Mar-janovic EJ, Devlin H. Tooth loss and osteoporo-sis: to assess the association between osteo-porosis status and tooth number. British dental journal. 2013 Feb;214(4): E10-.
4. Nicopoulou‐Karayianni K, Tzoutzoukos P, Mitsea A, Karayiannis A, Tsiklakis K, Jacobs R, Lindh C, Van Der Stelt P, Allen P, Graham J, Horner K. Tooth loss and osteoporosis: the OSTEODENT Study. Journal of clinical periodontology. 2009 Mar;36(3):190-7.
5. Kim HJ, Kim YH, Cho KH, Han BD, Kim SM, Choi YS, Kim DH, Han KD, Lee YJ, Kim CM. Oral health behaviors and bone mineral density in South Korea: the 2008–2010 Korean National health and nutrition examination survey. Journal of bone and mineral metabolism. 2016 Mar 1;34(2):225-33.
6. Holmstrup P, Damgaard C, Olsen I, Klinge B, Flyvbjerg A, Nielsen CH, Hansen PR. Comorbidity of periodontal disease: two sides of the same coin? An introduction for the clinician. Journal of oral microbiology. 2017 Jan 1;9(1):1332710.
7. Wactawski‐Wende J. Periodontal diseases and osteoporosis: association and mechanisms. Annals of periodontology. 2001 Dec;6(1):197-208.
8. Penoni DC, Fidalgo TK, Torres SR, Varela VM, Masterson D, Leão AT, Maia LC. Bone density and clinical periodontal attachment in postmen-opausal women: a systematic review and me-ta-analysis. Journal of dental research. 2017 Mar;96(3):261-9.
9. Martínez-Maestre MÁ, González-Cejudo C, Ma-chuca G, Torrejon R, Castelo-Branco C. Perio-dontitis and osteoporosis: a systematic review. Climacteric. 2010 Dec 1;13(6):523-9.
10. Zhang Q, Witter DJ, Gerritsen AE, Bronkhorst EM, Creugers NH. Functional dental status and oral health-related quality of life in an over 40 years old Chinese population. Clinical oral investigations. 2013 Jul 1;17(6):1471-80.
11. World Health Organization. Oral Health Surveys: Basic Methods. 5th ed. Geneva: World Health Organization; 2013.
12. Mohammad AR, Brunsvold M, Bauer R (1996). The strength of association between systemic post-menopausal osteoporosis and periodontal dis-ease. Int. J. Prosthond. 9: 47.
13. Tezal M, Wactawski-Wende J, Grossi SG, Ho AW, Dunford R, Genco RJ (2000). The relationships between bone mineral density and periodontitis in postmenopausal women. J. Periodontol. 71: 1492–1498.
14. Straka M, Straka-Trapezanlidis M, Deglovic J, Varga I. Periodontitis and osteoporosis. Neuro-endocrinology Letters. 2015 Jan 1;36(5).
15. Payne JB, Reinhardt RA, Nummikoski PV, Patil KD. Longitudinal alveolar bone loss in post-menopausal osteoporotic/osteopenic women. Osteoporosis International. 1999 Aug 1;10(1):34-40.
16. Straka M, Straka-Trapezanlidis M, Deglovic J, Varga I. Periodontitis and osteoporosis. Neuro-endocrinology Letters. 2015 Jan 1;36(5).
17. Renvert S, Berglund J, Persson R (2011). Oste-oporosis and periodontitis in older subjects par-ticipating in the Swedish National Survey on Ageing and Care (SNAC-Bleking). Acta Odontol. Scan. 69: 201–207.
18. Wactawski-Wende J, Hausmann E, Hovey K, Trevisan M, Grossi S, Genco RJ. The association between osteoporosis and alveolar crestal height in postmenopausal women. J Periodontol. 2005;76(Suppl.):2116-24.
19. Moedano DE, Irigoyen ME, Borgez-Yanez A, Flores-Sánchez I, Rotter RC (2011). Osteoporosis, the risk of vertebral fracture, and periodontal disease in an elderly group in Mexico City. Ger-ontology. 28: 19–24.
20. Clark P, Cons-Molina F, Delez M, Ragi-Eis S, Haddock L, Zanchetta JR (2009). The prevalence of radiographic vertebral fractures in Latin Amer-ican countries: The Latin American Vertebral Os-teoporosis Study (LAVOS). Osteoporosis Intern. 20: 275–282.
21. Genco RJ, Borgnakke WS. Risk factors for per-iodontal disease. Periodontology 2000. 2013; 62:59-94.
22. Ward VJ, Manson JD. Alveolar bone loss in periodontal disease and the metacarpal index. Journal of Periodontology. 1973 Dec;44(12):763-9.
23. JJ G. Menczel J, Shapiro S: Chronic destructive periodontal disease in patients with presenile osteoporosis. J Periodontal disease in patients with presenile osteoporosis. J Periodontol.1968; 39:19-23.
24. von Wowern N, Klausen B, Ølgaard K. Steroid‐induced mandibular bone loss in relation to mar-ginal periodontal changes. Journal of clinical periodontology. 1992 Mar;19(3):182-6.
25. Mohammad AR, Bauer RL, Yeh CK. Spinal bone density and tooth loss in a cohort of postmeno-pausal women. International Journal of Prostho-dontics. 1997 Jul 1;10(4).
26. Martinez-Maestre MA, Machuca G, Gonza-lez-Cejudo C, Flores JR, Cardoso RT, Caste-lo-Branco C. Osteoporosis, fragility fracture, and periodontal disease: a cross-sectional study in Spanish postmenopausal women. Menopause. 2013; 20:79-84.
27. Phillips, H., Ashley, F. The relationship between periodontal disease and a metacarpal bone index. Br Dent J 134, 237–239 (1973).
a. https://doi.org/10.1038/sj.bdj.4802984
28. Kribbs PJ, Chesnut CH, Ott SM, Kilcoyne RF. Relationships between mandibular and skeletal bone in an osteoporotic population. Journal of Prosthetic Dentistry. 1989 Dec 1;62(6):703-7.
29. Elders PJ, Habets LL, Netelenbos JC, van der Linden LW, van der Sieit PF. The relation between periodontitis and systemic bone mass in women between 46 and 55 years of age. Journal of clin-ical periodontology. 1992 Aug;19(7):492-6.
30. Hildebolt CF, Pilgram TK, Dotson M, Yokoya-ma-Crothers N, Muckerman J, Mauser J, Cohen S, Kardaris E, Vannier MW, Hanes P, Shrout MK. Attachment loss with postmenopausal age and smoking. Journal of periodontal research. 1997 Oct;32(7):619-25.
31. Kribbs PJ, Smith DE, Chesnut CH. Oral findings in osteoporosis. Part II: Relationship between re-sidual ridge and alveolar bone resorption and generalized skeletal osteopenia. Journal of Prosthetic Dentistry. 1983 Nov 1;50(5):719-24.
32. Phipps KR, Chan BK, Madden TE, Geurs NC, Reddy MS, Lewis CE et al (2007). Longitudinal study of bone density and periodontal disease in men. J. Dent.Res. 86: 1110–1114.
33. Aström J, Bäckström C, Thidevall G. Tooth loss and hip fractures in the elderly. J Bone Joint Surg Br 1990; 72: 324–325.
34. May H, Reader R, Murphy S, Khaw K T. Self-reported tooth loss and bone mineral density in older men and women. Age Ageing 1995; 24: 217–221.
35. Streckfus C F, Johnson R B, Nick T, Tsao A, Tucci M. Comparison of alveolar bone loss, al-veolar bone density and second metacarpal bone density, salivary and gingival crevicular fluid in-terleukin-6 concentrations in healthy premeno-pausal and postmenopausal women on estrogen therapy. J Gerontol a Biol Sci Med Sci 1997; 52: M343-M351.
36. Daniell H W. Postmenopausal tooth loss. Con-tributions to edentulism by osteoporosis and cigarette smoking. Arch Intern Med 1983; 143: 1678–1682.
37. von Wowern N, Klausen B, Kollerup G. Osteo-porosis: a risk factor in periodontal diease. J Periodontol 1994; 65: 1134–1138.
38. Taguchi A, Suei Y, Ohtsuka M, Otani K, Tanimoto K, Hollender L G. Relationship between bone mineral density and tooth loss in elderly Japanese women. Dentomaxillofacial Radiol 1999; 28: 219–223.
39. Earnshaw S A, Keating N, Hosking D J et al. Tooth counts do not predict bone mineral density in early postmenopausal Caucasian women. EPIC study group. Int J Epidemiol 1998; 27: 479–483.