Gum Disease and Osteoporosis

By Joseph Preziosi Jr., DMD

It has long been accepted that bone loss is the central feature that is common to both periodontal disease (gum disease) and osteoporosis or systemic bone loss. A deficiency in bone mineral density or BMD is called osteopenia and results from the body resorbing more bone, through the action of osteoclast cells, than it is producing through osteoblast cells.

The World Heath Organization defines osteoporosis as a BMD that is less than 2.5 standard deviations below the mean or average peak bone density for young woman. The prevalence of osteoporosis is higher in woman than men and increases with age with approximately 35% of post-menopausal white and Asian woman suffering from osteoporosis of the hip, spine or forearm.

These statistics translate into an increased risk of bone fractures. In fact after the age of 50 years old 50% of woman and 25% of men will have an osteoporosis-related fracture with an associated direct cost of treating hip fractures that exceeded $18 billion in the USA alone in 2002.

Gum disease or periodontal disease is a chronic infection of the soft tissues that surround the teeth that causes chronic inflammation or edema as well as chronic erythema or redness of the gum tissues. This ultimately leads to the destruction of the oral bone and periodontal ligament that attaches the root of the tooth to the oral bone and consequently the eventual loss of the teeth themselves.

Gum disease and the associated oral soft tissue inflammation increase the body’s production of cytokines, such as interlukin- 6, which are chemical compounds that stimulate the activity of the osteoclast cells thus promoting bone resorption.

Osteoporosis may be mediated by a similar mechanism of action thus raising the question of whether patients with a low skeletal BMD are at an increased risk of developing oral osteoopinia. To date there are several veins of evidence that support an association between osteoporosis and gum diseases or periodontal diseases.

There are several common risk factors to both gum disease and osteoporosis. They both show a marked predisposition for patients who have a family history of either or both diseases. Both become more prevalent as the patient ages with a marked increase in occurrence and severity after the age of 50years old. Smoking is a risk factor for both diseases and hastens the progression of both. Estrogen deficiency in woman associated with menopause increases the risk of both oral and systemic osteopenia.

Many studies have demonstrated an association between gum disease or periodontal disease and low systemic BMD irrespective of whether the measure of periodontal diseases is clinical, attachment loss and or pocket probing depths, or radiographic, loss of alveolar crestal bone height. There are also some therapies that improve both low systemic BMD as well as improving measures of periodontal or gum disease.

These data suggest an underlying connection of low systemic BMD to gum disease. The three classes of treatment that have been implicated in this regard are hormone replacement therapy (HRT), diet supplementation with calcium and vitamin D, and bisphosphonates.

All this evidence suggests an association between low systemic BMD and gum diseases although the underlying biophysical and biochemical mechanisms of action are unknown. Patients with low systemic BMD may also have low alveolar crestal bone density, which may allow periodontal disease to progress more rapidly due to lack of oral bone that is present.

Regardless of the mechanism of action patients with low systemic BMD appear to be at a greater risk for developing gum diseased and having the gum disease progress more rapidly than patients without osteoporosis. It is therefore especially important for patients with osteoporosis or who are at high risk for systemic bone loss to prevent oral inflammation through good oral hygiene and regular dental visits.