Osteoporosis: A Study of Female Dental Patients in a Diverse Population

Abstract

Osteoporosis is a silent disease of bone that affects both genders and all ethnic groups to a varying extent. However, older adults and especially females are the highest risk in all ethnic groups. Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro-architectural deterioration of the bone scaffold that results in increased bone fragility with susceptibility to fracture. The bones most frequently involved with fractures are the vertebrae in the lower dorsal and lumbar areas. Osteoporosis may affect any bone, including the jaws. In many phases of dentistry, healthy bone with normal regenerative capacity is essential for a successful outcome. Therefore, it is important to know bone quantity and quality of the jaws in the multiple disciplines of dentistry. The focus of this present study was to test the association of osteoporosis risk with the presence of periodontal disease and missing teeth for the patient population in different clinical settings. The assessment of the osteoporosis risk factors involved four ethnic groups: African-American, Asian (Japanese, Chinese, Korean and Vietnamese), Hispanic (primarily of Mexican extraction), and White Caucasian (European extraction). The sample was obtained from clinics at Indiana University School of Dentistry and selected private practices (westside and midtown) in the Indianapolis area and consisted of 311 patients. Evaluation of risk was calculated using questionnaires, the periodontal screening record index (PSR) and the number of missing teeth. Initially patients were placed into categories depending on estrogen status. (Category 4=estrogen deficient, multiple risks, 3=estrogen deficient, no risk, 2= no estrogen deficiency, multiple risks, 1 = no estrogen deficiency, single risk, 0=no risk factors). The patients were then categorized into 3 risk levels (risk level 0= category 0= categories 1 and 2, 2= categories 3 and 4) with risk level 2 considered the "at risk group". The IUSD clinic had the lowest percentage in the "at risk" group (risk level 2 at 3.88 percent vs. midtown at 12.61 percent and westside at 6.19 percent). A chi-square test was used to determine if there is a significant difference in the proportion of patients with periodontal disease by the three risk levels for osteoporosis. With every 5 years increase in the patients age, the odds of abnormal PSR were 1.5 times higher (95% CI: 1.36-4.05, p-value<0.0001). An analysis of variance (ANOVA) model was used to test for significant mean differences in the number of missing teeth between patients in the three risk levels after adjusting for age, race and body mass index (BMI). Risk levels did significantly impact the number of missing teeth. This impact was confounded by clinic. The risk level 2 at the midtown clinic had the lowest number of missing teeth (1.52 at the risk level 2 vs. 2.38 at risk level 0 and 2.96 at risk level 1). And finally, a Poisson regression model was used to test for a difference in the number of abnormal sextants among the three risk levels after adjusting for age, race and BMI. The differences in the number of abnormal sextants among the three risk levels were significant. The risk level 2 had the highest number of abnormal sextants (1.81 at level 2 vs. 0.98 at the level 0 and 1.09 at the level 1, p-value<0.0001). African-Americans are also at risk for osteoporosis. Risk levels were impacted by missing teeth although confounded by clinic (midtown clinic had the lowest number of missing teeth at the highest risk level compared to lower levels in this sample). The PSR index correlated to the 3 risk levels. Therefore, it was determined to be an adequate screening tool.