AbstractOsteoporosis and periodontitis are an inevitable result of an imbalance in bone resorption and formation rates which leads to decreased mineral mass. Without the presence of minerals, the bone is at much higher risk for fractures. Unfortunately, conventional measures of radiography are not sophisticated enough to detect or diagnose the brittle bone disease until the patient’s total density has experienced a 50 percent decline. Known by shorthand as DXA, dual energy x-ray absorptiometry is utilized as a metric for measuring bone mass index expressed by area with grams per centimeters squared as units. Various studies suggest a strong connection between osteoporosis, periodontitis, and postmenopausal women (Palomo, Williams, Thacker, 2016). Osteoporosis and periodontitis are irreversible diseases, but they can be treated in ways that allow the bones to remain as strong as possible in order to avoid future fractures (Palomo, Williams, Thacker, 2016). However, each type of medication prescribed by the doctor will work in a completely different manner. For example, bisphosphonates including ibandronate avid, risedronic acid, and alendronate work to prevent the body from breaking down its own bones (WebMD, 2017).
Introduction
Osteoporosis is defined as a disease of the human skeletal system caused by micro architectural alterations in the bone and a reduction in overall mass which leads to increased fragility. Professionals in the medical industry hold an identical standard for diagnosis; marked by the ratio of bone mineral density and x-ray absorptiometry. The disease is an inevitable result of an imbalance in bone resorption and formation rates which leads to decreased mineral mass. Decreased minerals leave the bone at much higher risk for fractures. This problem typically effects the elderly population and substantially increases chance of death, permanent mobility limitations, significantly hinders daily living activity performance, and the requirement of nursing care on the long-term scale (Juluri et al, 2015). A large percentage of the risk factors which have the potential to lead to osteoporosis are preventable given the fact that they are related to the environment. Several of the established factors of risk include advanced age, being female, and being in the postmenopausal stage. Naturally, the risk increases if the patient holds a combination of the aforementioned attributes.
Detection Methods
Unfortunately, conventional measures of radiography are not sophisticated enough to detect or diagnose the brittle bone disease until the patient’s total density has experienced a 50 percent decline. Known by shorthand as DXA, dual energy x-ray absorptiometry is utilized as a metric for measuring bone mass index expressed by area with grams per centimeters squared as units. According to the World Health Organization, osteoporosis is diagnosed in those who possess a density that exceeds 2 and a half standard deviations below the mean of young adults in the female population spanning the ages of 20 to 40 years old (Juluri et al, 2015). Divided into two different classifications, osteoporosis can be either primary or secondary. Primary osteoporosis is typically associated with a decrease in the amount of sex hormones a person has in addition to an advanced state of age. Secondary osteoporosis implies a cause that is beneath the surface such as systemic diseases, low intake of calcium, or utilization of certain prescription drugs. Periodontal disease is defined as a chronic affliction which has the potential to occur in children, adults, or members of the youth. Pathogens located in the biofilm of the teeth become inflamed and naturally lead to a bacterial overflow in the gingiva, commonly referred to as gingivitis (Juluri et al, 2015) Upon the destruction of the periodontal tissue and loss of alveolar bone, the patient is diagnosed with periodontitis.
Signs and Symptoms
New studies were conducted by Streckfus et al. who designed numerous quantitative factors for measuring hand radiographs and vertical dimension in just under 30 healthy American women and just over 20 suffering from periodontitis. According to the results of the research, they discovered that postmenopausal women being treated with estrogen replacement therapy had more missing dentures, increased alveolar bone laws, and a sharp reduction in second metacarpal bone density than premenopausal women (Palomo, Williams, Thacker, 2016). Additionally, Southard et al. utilized systemic bone densities and quantitative intraoral radiography with DXA as a determinant in over 60 Caucasian American women. An immense correlation between the density of mandibular and maxillary alveolar process, hip and radius, and lumbar spine in the group of healthy women existed (Cummings et al, 2017). Moreover, a selection of nearly 70 postmenopausal women who possessed zero to mild periodontal disease was made by Shrout et al. to compare trabecular pattern complexity of the digital bitewings with the femoral bone mass index, the lumbar spine and complexities (Cummings et al, 2017).
Risk Factors
Despite the fact that osteoporosis and periodontal disease are often mentioned together, the former is suspected as a risk factor of the latter. In a study conducted by the Department of Oral and Maxillofacial Surgery, a group of 12 female patients suffering from fractures were compared with 14 women possessing healthy bones. The normal group underwent clinical examination with respect to plaque in their teeth, gingival bleeding, and any lost attachments from their 6 index teeth (Ramfjord). The bone mineral content of both the forearm and the mandible were calculated via dual photon scanning. With respect to age, smoking habits, and menopausal period, the two groups faired comparably at a ratio of 68.3 +- 1.8 years for the sick group against 68.1 +- 1.5 years for the health group, 4 smokers for sick and 2 for normal, and 47.5 +- 1.8 years versus 47.2 +- 1.3 respectively. Although these statistics have little to no affect on periodontal disease, a significant loss in attachment was observed in women suffering from osteoporosis, at a rate of 3.65 +- 0.18mm in the sick group and 2.86 +- 0.19mm in the normal group.
Treatment
Osteoporosis and periodontitis are irreversible diseases, but they can be treated in ways that allow the bones to remain as strong as possible in order to avoid future fractures (Palomo, Williams, Thacker, 2016). However, each type of medication prescribed by the doctor will work in a completely different manner. For example, bisphosphonates including but limited to ibandronate avid, risedronic acid, and alendronate work to prevent the body from breaking down its own bones (WebMD, 2017). Many of these types of medications can be taken once on a monthly basis whilst others can be consumed on a weekly basis. Conversely, alternative medications such as zoledronic acid is delivered intravenously for 15 minutes on an annual basis which increases the strength of the bones and attempts to reduce the possibility of fractures in the hip, wrist, leg, ribs, spine, and arms (WebMD, 2017). Aside from prescription medication, hormone replacement therapy which can the take the form of a combination of progestin and estrogen or just pure estrogen are both approved for the treatment and prevention of these diseases.
Discussion and Conclusion
It is critical for medical professionals to identify the key risk factors as related to individual patients whilst subsequently creating strategies of prevention for them, as in the case of osteoporosis and periodontal disease, the best treatment is to never allow such an affliction to happen in the first place. The National Osteoporosis Foundation has suggested several concepts of focus. As every woman (the gender most at risk for the disease) should be counseled and educated on the various factors responsible, every one entering the post menopausal stage of life should undergo bone mineral density evaluation, including and especially those who already suffer from fractures in order to determine the severity of the disease and formulate a diagnosis as early as possible. Regardless of additional factors of risk, any woman over the age of 65 is recommended to acquire an evaluation on their current bone mineral density. Diagnosed patients are recommended to alter their dietary calcium intake to adequate rates. Regularly muscle strengthening and weight bearing exercises should be implemented to reduce further fractures and falls risks. Smokers should be encouraged to quit the habit by following cessation plans. Intake of alcohol should be reduced to only one beverage per day.
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