Nutrition and Oral Medicine (Nutrition and Health)

262 Part IV / Select Diseases and ConditionsTable 1Common Risk Factors for Primary and Secondary OsteoporosisPrimary osteoporosis• Advanced age• Female sex• Postmenopause• White or Asian ethnicity• Family history of osteoporosis or low-trauma fracture• Low body weight• Low dietary intakes of calcium and vitamin D• Low physical activity level• Cigarette smokingSecondary osteoporosis• Hypogonadism (male and female)• Use of glucocorticoid or anticonvulsant medication• Excess thyroid hormone• Alcoholismto values for a healthy, young, gender-specific reference population. The risk of fracturedoubles for each 1 standard deviation increment below the reference value. The WorldHealth Organization defines osteoporosis in women as BMD that is more than 2.5 standarddeviations below the average value for a young healthy female, and osteopenia asBMD between 1 and 2.5 standard deviations below average (3).3. EPIDEMIOLOGY OF OSTEOPOROSISIn the United States, it is estimated that at least 8 million women and 2 million menhave osteoporosis, and another 34 million individuals have osteopenia (4). After age 50,the lifetime risk of any fracture of the hip, spine, or distal forearm is nearly 40% for whitewomen and 13% for white males (5). Age and gender are two important risk factors forosteoporosis. A woman’s risk is higher because on average, she will generally haveachieved a lower peak bone mass as a young adult than a man, and her bone loss isaccelerated during the 5 to 10 yr surrounding the menopause. A number of medicalconditions and medications may also result in osteoporosis as a secondary outcome. Riskfactors for primary and secondary osteoporosis are shown in Table 1. Known risk factorsfor periodontal disease also include age, smoking, race, socioeconomic status, diabetes,and genetic susceptibility (6). Although osteoporosis and periodontal disease share somerisk factors (age, smoking, and ethnicity), the relationships are not entirely consistent inboth diseases. The prevalence of periodontal disease is greater with age and cigarette use,but lower in whites than in blacks (6), whereas age, cigarette smoking, and white ethnicityall increase the risk of osteoporosis.