Nutrition and Oral Medicine (Nutrition and Health)

Chapter 15 / Osteoporosis 2655. EFFECTS OF OSTEOPOROSIS PREVENTIONAND TREATMENT STRATEGIES ON THE ORAL CAVITY5.1. Medications for the Treatment of OsteoporosisApproved treatments for osteoporosis include hormone replacement therapy (HRT),the hormone calcitonin, and antiresorptive medications. The bis-phosphonate class ofantiresorptive medication has been shown to prevent alveolar bone resorption and preservemandibular bone mass in animals (27). In humans, the therapy that has been studiedmost extensively is HRT, either estrogen alone or a combination of estrogen and progestin.Three large population-based studies of postmenopausal women found that womenwho have ever used HRT retain more teeth than nonusers and have a lower likelihood ofbeing edentate (28–30) independent of age, smoking, and other factors. Duration of usewas also related to tooth retention. For each 4-yr increment in the duration of HRT use,the number of teeth retained increased by one and the risk of edentulism decreased byabout 25% (28,29). Payne, Reinhardt, and colleagues reported that estrogen sufficiencyis associated with preservation of alveolar bone density and less frequent CAL (9,31–33).HRT appears to also have beneficial effects on soft periodontal tissues, since it is associatedwith less bleeding on probing (33,34).5.2. Nutritional Approaches to Osteoporosis5.2.1. CALCIUM AND VITAMIN DA randomized, controlled trial in children demonstrated that increasing intake ofcalcium from an average of about 900 mg/d to 1600 mg/d enhanced the rate of increasein bone density during growth (35). Several placebo-controlled studies in older adults ofcalcium and vitamin D supplements showed that higher intakes of these nutrients slowthe rate of bone mineral loss (36–38) and reduce the risk of fracture (39). The usual dietaryintakes of calcium and vitamin D among subjects in these studies generally were below800 mg and 200 IU/d, respectively, and the content of the supplements ranged from 500to 1200 mg of calcium (36,39) and 200 to 800 IU of vitamin D (38,39). Osteoporosis-likechanges in oral bone of animals can be prevented by a diet containing an adequate amountof calcium (40–42), but clinical signs of periodontal disease are not affected. A 1-yrcontrolled trial of calcium supplementation in humans did not find a difference in periodontaldisease indices between the calcium and placebo groups (43), but it is possiblethat a longer follow-up time is needed to observe an effect.A prospective analysis in 552 older men suggested that higher calcium intake levelsmay be beneficial in slowing alveolar bone loss (44). Progression of alveolar bone lossat each tooth was defined as a change from minimal bone loss (80% or more of alveolarbone remaining around the tooth) to bone loss (less than 80% of bone remaining), and thetotal number of teeth with progression was computed for each participant. Men whosecalcium intakes were above 1000 mg/d had fewer teeth exhibiting progression of alveolarbone loss over an average 4-yr follow-up period (2.0 ± 2.5 teeth) compared to men withcalcium intakes below this level (2.6 ± 2.0 teeth, p = 0.04), controlling for age, initialnumber of teeth, smoking status, vitamin D intake, caries status, and clinical periodontaldisease status.Nishida et al. (45) analyzed dietary intake surveys and periodontal data in more than12,000 adults from NHANES III. After controlling for age and smoking status, there was