• Elizabeth A. Krall
Part of the Nutrition and Health book series (NH)


Tooth loss and periodontal diseases become more prevalent with advancing age and result from the interaction of many factors, including local oral conditions, poor hygiene practices, lack of access to dental care, genetics, and systemic diseases. Osteoporosis is characterized by a decline in bone density and quality that predisposes to fracture and is one of several systemic diseases that has been hypothesized to increase the risks of periodontal disease and tooth loss 1. Although the number of studies of these associations continues to grow as precise methods to measure both oral and systemic bone mineral density are developed, a physiological mechanism for the associations between osteoporosis and these oral conditions has yet to be clearly identified. The majority of human studies to date have not been able to distinguish between causation and mere association.


Bone Mineral Density Hormone Replacement Therapy Oral Health Periodontal Disease Alveolar Bone 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Wactawski-Wende J, Grossi SG, Trevisan M, et al. The role of osteopenia in oral bone loss and periodontal disease. J Periodontol 1996; 67(Suppl.):1076–1084.Google Scholar
  2. 2.
    Mundy GR. Bone remodeling. In Favus MJ, ed. Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. Philadelphia, PA: Lippincott Williams & Wilkins, 1999, 30–38.Google Scholar
  3. 3.
    The WHO Study Group. Assessment of Fracture Risk and Its Application to Screening for Postmenopausal Osteoporosis. Geneva, Switzerland: World Health Organization, 1994.Google Scholar
  4. 4.
    National Osteoporosis Foundation. Fast facts on osteoporosis. Website: ( Accessed July 31, 2003.
  5. 5.
    Melton LJ III, Chrischilles EA, Cooper C, Lane AW, Riggs BL. How many women have osteoporosis? J Bone Miner Res 1992; 7:1005–1010.Google Scholar
  6. 6.
    Pihlstrom BL. Periodontal risk assessment, diagnosis and treatment planning. Periodontology 2000 2001; 25:37–58.CrossRefGoogle Scholar
  7. 7.
    Albandar JM, Brunelle JA, Kingman A. Destructive periodontal disease in adults 30 years of age and older in the United States, 1988–1994. J Periodontol 1999; 70:13–29.CrossRefGoogle Scholar
  8. 8.
    Marcus SE, Drury TF, Brown LJ, Zion GR. Tooth retention and tooth loss in the permanent dentition of adults: United States, 1988–1991. J Dent Res 1996; 75(Spec Issue):684–695.Google Scholar
  9. 9.
    Payne JB, Reinhardt RA, Nummikoski PV, Patil KD. Longitudinal alveolar bone loss in postmenopausal osteoporotic/osteopenic women. Osteoporosis Int 1999; 10:34–40.CrossRefGoogle Scholar
  10. 10.
    Ronderos M, Jacobs DR, Himes JH, Pihlstrom BL. Associations of periodontal disease with femoral bone mineral density and estrogen replacement therapy: cross-sectional evaluation of adults from NHANES III. J Clin Periodontol 2000; 27:778–786.CrossRefGoogle Scholar
  11. 11.
    Krall EA, Garcia RI, Dawson-Hughes B. Increased risk of tooth loss is related to bone loss at the whole body, hip, and spine. Calc Tiss Int 1996; 9:433–437.CrossRefGoogle Scholar
  12. 12.
    May H, Reader R, Murphy S, Khaw KT. Self-reported tooth loss and bone mineral density in older men and women. Age Ageing 1995; 24:217–221.CrossRefGoogle Scholar
  13. 13.
    Krall EA, Dawson-Hughes B, Papas A, Garcia RI. Tooth loss and skeletal bone density in healthy postmenopausal women. Osteoporosis Int 1994; 4:104–109.CrossRefGoogle Scholar
  14. 14.
    Daniell HW. Postmenopausal tooth loss: contributions to edentulism by osteoporosis and cigarette smoking. Arch Intern Med 1983; 143:1678–1682.CrossRefGoogle Scholar
  15. 15.
    Elders PJ, Habets LL, Netelenbos JC, van der Linden LW, van der Stelt PF. The relation between periodontitis and systemic bone mass in women between 46 and 55 years of age. J Clin Periodontol 1992; 19:492–496.CrossRefGoogle Scholar
  16. 16.
    Weyant RJ, Pearlstein ME, Churak AP, Forrest K, Famili P, Cauley JA. The association between osteopenia and periodontal attachment loss in older women. J Periodontol 1999; 70:982–991.CrossRefGoogle Scholar
  17. 17.
    Klemetti E, Collin HL, Forss H, Markkanen H, Lassila V. Mineral status of skeleton and advanced periodontal disease. J Clin Periodontol 1994; 21:184–188.CrossRefGoogle Scholar
  18. 18.
    Earnshaw SA, Keating N, Hosking DJ, et al., for the EPIC study group. Tooth counts do not predict bone mineral density in early postmenopausal Caucasian women. Int J Epidemiol 1998; 27:479–483.CrossRefGoogle Scholar
  19. 19.
    Streckfus CF, Johnson RB, Nick T, Tsao A, Tucci M. Comparison of alveolar bone loss, alveolar bone density and second metacarpal bone density, salivary and gingival crevicular fluid interleukin-6 concentrations in healthy premenopausal and postmenopausal women on estrogen therapy. J Gerontol Series A: Biol Sci Med Sci 1997; 52:M343–M351.Google Scholar
  20. 20.
    Engel MB, Rosenberg HM, Jordan SL, Holm K. Radiological evaluation of bone status in the jaw and in the vertebral column in a group of women. Gerodontol 1994; 11:86–92.CrossRefGoogle Scholar
  21. 21.
    Southard KA, Southard TE, Schlechte JA, Meis PA. The relationship between the density of the alveolar processes and that of post-cranial bone. J Dent Res 2000; 79:964–969.Google Scholar
  22. 22.
    Kribbs PJ, Smith DE, Chesnut CH III. Oral findings in osteoporosis. 2. Relationship between residual ridge and alveolar bone resorption and generalized skeletal osteopenia. J Prosthet Dent 1983; 50:719–724.CrossRefGoogle Scholar
  23. 23.
    Kribbs PJ, Chesnut CH III, Ott SM, Kilcoyne RF. Relationships between mandibular and skeletal bone in an osteoporotic population. J Prosthet Dent 1989; 62:703–707.CrossRefGoogle Scholar
  24. 24.
    Klemetti E, Vainio P. Effect of bone mineral density in skeleton and mandible on extraction of teeth and clinical alveolar height. J Prosthet Dent 1993; 70:21–25.CrossRefGoogle Scholar
  25. 25.
    Klemetti E, Vainio P, Lassila V, Alhava E. Cortical bone mineral density in the mandible and osteoporosis status in postmenopausal women. Scand J Dent Res 1993; 101:219–223.Google Scholar
  26. 26.
    Mercier P, Inoue S. Bone density and serum minerals in cases of residual alveolar ridge atrophy. J Prosthet Dent 1981; 46:250–255.CrossRefGoogle Scholar
  27. 27.
    Reddy MS, Weatherford TW III, Smith CA, West BD, Jeffcoat MK, Jacks TM. Alendronate treatment of naturally-occurring periodontitis in beagle dogs. J Periodontol 1995; 66:211–217.Google Scholar
  28. 28.
    Krall EA, Dawson-Hughes B, Hannan MT, Wilson PWF, Keil DP. Postmenopausal estrogen use and tooth retention. Am J Med 1997; 102:536–542.CrossRefGoogle Scholar
  29. 29.
    Grodstein F, Colditz GA, Stampfer MJ. Post-menopausal hormone use and tooth loss: a prospective study. J Amer Dent Assoc 1996; 127:370–377.Google Scholar
  30. 30.
    Paganini-Hill A. The benefits of estrogen replacement therapy on oral health: the Leisure World cohort. Arch Intern Med 1995; 155:2325–2329.CrossRefGoogle Scholar
  31. 31.
    Payne JB, Zachs NR, Reinhardt RA, Nummikoski PV, Patil K. The association between estrogen status and alveolar bone density changes in postmenopausal women with a history of periodontitis. J Periodontol 1997; 68:24–31.Google Scholar
  32. 32.
    Reinhardt RA, Payne JB, Maze C, Babbitt M, Nummikoski PV, Dunning D. Gingival fluid IL-1beta in postmenopausal females on supportive periodontal therapy: a longitudinal 2-year study. J Clin Periodontol 1998; 25:1029–1035.CrossRefGoogle Scholar
  33. 33.
    Reinhardt RA, Payne JB, Maze CA, Patil KD, Gallagher SJ, Mattson JS. Influence of estrogen and osteopenia/osteoporosis on clinical periodontitis in postmenopausal women. J Periodontol 1999; 70: 823–828.CrossRefGoogle Scholar
  34. 34.
    Norderyd OM, Grossi SG, Machtei EE, et al. Periodontal status of women taking postmenopausal estrogen supplementation. J Periodontol 1993; 64:957–962.Google Scholar
  35. 35.
    Johnston CC Jr, Miller JZ, Slemenda CW, et al. Calcium supplementation and increases in bone mineral density in children. N Engl J Med 1992; 327:82–87.CrossRefGoogle Scholar
  36. 36.
    Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. A controlled trial of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997; 337: 670–676.CrossRefGoogle Scholar
  37. 37.
    Prince R, Devine A, Dick I, et al. The effects of calcium supplementation (milk powder or tablets) and exercise on bone density in postmenopausal women. J Bone Miner Res 1995; 10:1068–1075.CrossRefGoogle Scholar
  38. 38.
    Peacock M, Liu G, Carey M, et al. Effect of calcium or 25OH vitamin D3 dietary supplementation on bone loss at the hip in men and women over the age of 60. J Clin Endocrinol Metab 2000; 85:3011–3019.CrossRefGoogle Scholar
  39. 39.
    Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 1992; 327:1637–1642.CrossRefGoogle Scholar
  40. 40.
    Bissada NF, DeMarco TJ. The effect of a hypocalcemic diet on the periodontal structures of the adult rat. J Periodontol 1974; 45:739–745.Google Scholar
  41. 41.
    Oliver WM. The effect of deficiencies of calcium, vitamin D or calcium and vitamin D and of variations in the source of dietary protein on the supporting tissues of the rat molar. J Periodont Res 1969; 4:56–69.CrossRefGoogle Scholar
  42. 42.
    Ferguson HW, Hartles RL. The effects of diets deficient in calcium or phosphorus in the presence and absence of supplements of vitamin D on the secondary cementum and alveolar bone of young rats. Arch Oral Biol 1964; 9:647–658.CrossRefGoogle Scholar
  43. 43.
    Uhrbom E, Jacobson L. Calcium and periodontitis: clinical effect of calcium medication. J Clin Periodontol 1984; 11:230–241.CrossRefGoogle Scholar
  44. 44.
    Krall EA. The periodontal-systemic connection: implications for treatment of patients with osteoporosis and periodontal disease. Ann Periodontol 2001; 6:209–213.CrossRefGoogle Scholar
  45. 45.
    Nishida M, Grossi SG, Dunford RG, Ho AW, Trevisan M, Genco RJ. Calcium and the risk for periodontal disease. J Periodontol 2000; 71:1057–1066.CrossRefGoogle Scholar
  46. 46.
    Krall EA, Wehler C, Harris SS, Garcia RI, Dawson-Hughes B. Calcium and vitamin D supplements reduce tooth loss in the elderly. Am J Med 2001; 111:452–456.CrossRefGoogle Scholar
  47. 47.
    Wical KE, Swoope CC. Studies of residual ridge resorption 2. The relationship of dietary calcium and phosphorus to residual ridge resorption. J Prosthet Dent 1974; 32:13–22.CrossRefGoogle Scholar
  48. 48.
    Wical KE, Brussee P. Effects of a calcium and vitamin D supplement on alveolar ridge resorption in immediate denture patients. J Prosthet Dent 1979; 41:4–411.CrossRefGoogle Scholar
  49. 49.
    Bloch AS, Shils ME. National and international recommended dietary reference values. In Shils, ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. Baltimore, MD: Williams & Wilkins, 1999, A19–A48.Google Scholar
  50. 50.
    Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002; 288:321–333.Google Scholar
  51. 51.
    Lydick E, Cook K, Turpin J, Melton M, Stine R, Byrnes C. Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density. Am J Manag Care 1998; 4:37–48.Google Scholar
  52. 52.
    Geusens P, Hochberg MC, van der Voort DJ, et al. Performance of risk indices for identifying low bone density in postmenopausal women. Mayo Clin Proc 2002; 77:629–637.CrossRefGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2005

Authors and Affiliations

  • Elizabeth A. Krall
    • 1
  1. 1.Department of Health Policy & Health Services ResearchBoston University Goldman School of Dental MedicineBoston

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