There are several identified risk factors for osteoporosis: family history, history of bone fracture secondary to mild/moderate trauma, loss of height (kyphosis), gender, age, early menopause, small-framed body, race, hereditary, low bone mass, body mass index (BMI) <19, low calcium intake (see question on dairy products below), lack of exercise, smoking, alcohol consumption, underlying disease (e.g., hyperthyroidism, multiple myeloma, hyperparathyroidism), systemic medications (e.g., long-term use of glucocorticosteroids), low testosterone levels in men.
Bone mineral density (BMD) is measured by dual energy x-ray absorptiometry (DEXA) scan in g/cm2. A DEXA report will compare a person’s values with those of a same-gender person, aged 20-80 years.
Normal (T-score) ≥-1.0 SD below young normal. (A negative number means there is bone loss.)
Osteopenia (T-score) – between -1 and -2.5 SD below young normal.
Osteoporosis (T-score) – <-2.5 SD below young normal.
Hip fractures are strongly associated with low BMD. Vertebral fractures result in an increased risk of death due to cardiovascular and pulmonary disease. These fractures also impact on physical disability, self-esteem, body image, and behavior.
Osteoporosis and consequent fractures are associated with significant pain, loss of mobility, and diminished ability for independent living.
|1-3 years||700 mg||700 mg|
|4-8 years||1,000 mg||1,000 mg|
|9-18 years||1,300 mg||1,300 mg|
|51-70 years||1,000 mg||1,200 mg|
|>70 years||1,200 mg||1,200 mg|
– dairy products (300-400 mg/serv) ideal source combining Ca + vit D
– fortified foods and fluids (+/- 300 mg/serv) orange juice, cereals
– tofu (200-300 mg/serv) in calcium sulfate bath (hard is best)
– vegetables (100-200 mg/serv) low oxalate sources
One of the more controversial medications for osteoporosis is oral bisphosphonate. This medication has been associated with antiresorptive agent-induced osteonecrosis of the jaw (ARONJ), also known as bisphosphonate-related osteonecrosis of the jaws (BRONJ) . Although the risk is extremely low – possibly around 5 cases per 10,000 person/year (see Bone HG, et al below) – risk factors may include palatal tori, long-term use of the medication, glucocorticosteroid therapy, periodontal and dental diseases, older age, female gender, and traumatic dental procedures.
Classifications and treatment strategies have been developed to assess and provide dental care for patients with ARONJ.
Other nonbisphosphonate-type medications used to treat osteoporosis, including denosumab (Prolia), an injectable human monoclonal antibody, have also been associated with osteonecrosis of the jaws.
- Oral Health Care Considerations
- Bone HG, et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol. 2017;5(7):513-523.
- Cusman F, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int (2014) 25:2359–2381
- Gourlay ML, et al. Bone-density testing interval and transition to osteoporosis in older women. NEJM. 2012;366(3):225-233
- Bone mineral density test. MedlinePlus. U.S. National Library of Medicine. June 9, 2021.
- Osteoporosis. MedlinePlus. U.S. National Library of Medicice. May 27, 2021.
- Osteoporosis. Office on Women's Health. U.S. Department of Health & Human Services. May 20, 2019.
- Osteoporosis Overview. National Institute of Arthritis and Musculoskeletal and Skin Diseases. NIH Osteoporosis and Related Bone Diseases. National Resource Center.
- Bone Density Scan. MedlinePlus. U.S. National Library of Medicine. August 13, 2020.