Nutrition and Oral Medicine (Nutrition and Health)

264 Part IV / Select Diseases and Conditionstotal femur was associated with average CAL values and percent of sites with moderateto severe CAL in women (10). The association appeared to depend on the level of calculussuch that women with very high or extremely high calculus index scores had up to 2.5times as many sites with CAL greater than 7 mm as women with comparable calculus butnormal BMD. Similar trends were seen in men. Others found only weak or no associationsbetween BMD and probing pocket depth or CAL (15,16). CAL and PPD valueswere higher in women with low BMD at multiple sites in a study of elderly women, butthe magnitude of the relationships was reduced when controlled for age, smoking, andnumber of teeth (16). One group (17) reported an opposite relationship: scores of theCommunity Periodontal Index of Treatment Needs were higher among women withhigher BMD, but these data were not adjusted for potential confounders. The findingsfrom these studies do not offer strong support for an association between BMD andclinical periodontal indices.4.3. Tooth LossThe most consistent studies in support of a positive association are prospective andlarge cross-sectional studies of elderly subjects in which tooth loss is the dependentvariable. In a prospective observational study of postmenopausal women, rates of boneloss at the hip, spine, and total body over a 7-yr period were higher in women whoconcurrently lost teeth than in women who retained teeth (11). In women who lost teethduring that period, bone loss was three times faster at the hip and total body than inwomen who lost no teeth. The risk of tooth loss increased by at least 50% for each 1%per year increment in the rate of systemic bone loss. However, there was no informationon other oral factors, such as caries burden, that cause tooth loss.May et al. (12) reported that self-reported number of teeth remaining correlated withBMD of the hip and spine in more than 1400 men and women aged 65 and older. AverageBMDs among edentate men were 5 to 9% lower than fully dentate men when adjusted forbody mass index (BMI), age, and smoking status. A similar trend of smaller magnitude wasseen in women, but the difference was not statistically significant. Krall et al. (13) reportedsignificant correlations between number of teeth retained and BMD of the forearm, spine,and hip in a group of 329 postmenopausal women after having controlled for BMI, menopausalage, and smoking status. Daniell (14) studied 208 women aged 60–69 yr and foundthat those with low cortical bone area of the metacarpals were more likely to have becomeedentate after the start of menopause, a trend that was most striking in nonsmokers.In contrast, Weyant et al. (16) saw no association between BMD at four skeletal sitesand number of teeth remaining in a group of 292 elderly women using multivariateanalyses. Two studies of early postmenopausal women also reported no associations ofteeth remaining with spine (15,18) or hip BMD (18).4.4. Alveolar Bone Height in Edentate and Partially Dentate SubjectsErosion of alveolar bone after tooth extraction is common and may cause denture fit toworsen over time. Findings from several (22–25) studies generally suggest a correlationbetween remaining bone height in the mandible and BMD at systemic sites, but not allstudies agree (26), and the strength of the relationship may not be consistent in all regionsof the jawbone (24). More studies are needed to determine how other factors such as age,mastication forces, and length of time since tooth extraction affect the relationship.