Skip to main content
SpringerLink
Log in

Assessment of Alveolar Bone Mineral Density as a Predictor of Lumbar Fracture Probability

  • Original Research
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Introduction

Osteoporosis and tooth loss have been linked with advancing age, but no clear relationship between these conditions has been proven. Several studies of bone mineral density measurements of the jaw and spine have shown similarities in their rate of age-related deterioration. Thus, measurements of jawbone density may predict lumbar vertebral bone density. Using jawbone density as a proxy marker would circumvent the need for lumbar bone measurements and facilitate prediction of osteoporotic spinal fracture susceptibility at dental clinics. We aimed to characterize the correlation between bone density in the jaw and spine and the incidence of osteoporotic spinal fractures.

Methods

We used computerized radiogrammetry to measure alveolar bone mineral density (al-BMD) and dual-energy X-ray absorptiometry to measure lumbar bone mineral density (L-BMD). L-BMD and al-BMD in 30 female patients (average age: 59 ± 5 years) were correlated with various patient attributes. Statistical analysis included area under the curve (AUC) and probability of asymptomatic significance (PAS) in a receiver operating characteristic curve. The predictive strength of L-BMD T-scores (L-BMD[T]) and al-BMD measurements for fracture occurrence was then compared using multivariate analysis with category weight scoring.

Results

L-BMD and al-BMD were significantly correlated with age, years since menopause, and alveolar bone thickness. Both were also negatively correlated with fracture incidence. Category weight scores were −0.275 for a L-BMD(T) <80%; +0.183 for a L-BMD(T) ≥80%; −0.860 for al-BMD <84.9 (brightness); and +0.860 for al-BMD ≥84.9. AUC and PAS analyses suggested that al-BMD had a higher association with fracture occurrence than L-BMD.

Conclusions

Our results suggest the possible association between al-BMD and vertebral fracture risk. Assessment of alveolar bone density may be useful in patients receiving routine dental exams to monitor the clinical picture and the potential course of osteoporosis in patients who may be at a higher risk of developing osteoporosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Jeffcoat MK. Osteoporosis: a possible modifying factor in oral bone loss. Ann Periodontol. 1998;3:312–21.

    Article  PubMed  CAS  Google Scholar 

  2. Martinez-Maestre MA, Gonzalez-Cejudo C, Machuca G, Torrejon R, Castelo-Branco C. Periodontitis and osteoporosis: a systematic review. Climacteric. 2010;13:523–9.

    Article  PubMed  Google Scholar 

  3. Krall EA, Garcia RI, Dawson-Hughes B. Increased risk of tooth loss is related to bone loss at the whole body, hip, and spine. Calcif Tissue Int. 1996;59:433–7.

    Article  PubMed  CAS  Google Scholar 

  4. Krall EA, Dawson-Hughes B, Papas A, Garcia RI. Tooth loss and skeletal bone density in healthy postmenopausal women. Osteoporos Int. 1994;4:104–9.

    Article  PubMed  CAS  Google Scholar 

  5. Groen JJ, Duyvensz F, Halsted JA. Diffuse alveolar atrophy of the jaw (non-inflammatory form of paradental disease) and pre-senile osteoporosis. Gerontol Clin. 1960;2:68–86.

    Article  CAS  Google Scholar 

  6. Taguchi A, Suei Y, Ohtsuka M, Otani K, Tanimoto K, Hollender LG. Relationship between bone mineral density and tooth loss in elderly Japanese women. Dentomaxillofac Radiol. 1999;28:291–300.

    Article  Google Scholar 

  7. Nicopoulou-Karayianni K, Tzoutzoukos P, Mitsea A, et al. Tooth loss and osteoporosis: the OSTEODENT study. J Clin Periodontol. 2010;36:190–7.

    Article  Google Scholar 

  8. Megson E, Kapellas K, Bartold PM. Relationship between periodontal disease and osteoporosis. Int J Evid Based Healthc. 2010;8:129–39.

    Article  PubMed  Google Scholar 

  9. Habashneh RA, Alchalabi H, Khaden YS, Hazza’a AM, Odat Z, Johnson GK. Association between periodontal disease and osteoporosis in postmenopausal women in Jordan. J Periodontol. 2010;81:1613–21.

    Article  PubMed  Google Scholar 

  10. Kribbs PJ, Smith DE, Chesnut CH 3rd. Oral findings in osteoporosis. Part I: measurement of mandibular bone density. J Prosthet Dent. 1983;50:576–9.

    Article  PubMed  CAS  Google Scholar 

  11. Manzke E, Chesnut CH III, Wergedal JE, Baylink DJ, Nelp WB. Relationship between local and total bone mass in osteoporosis. Metabolism. 1975;24:605–15.

    Article  PubMed  CAS  Google Scholar 

  12. 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;70:21–5.

    Article  CAS  Google Scholar 

  13. Earnshaw SA, Keating N, Hosking DJ, et al. Tooth counts do not predict bone mineral density in early postmenopausal Caucasian women. EPIC study group. Int J Epidemiol. 1998;27:479–83.

    Article  PubMed  CAS  Google Scholar 

  14. Jonasson G, Alstad T, Vahedi F, Bosaeus I, Lissner L, Hakeberg M. Trabecular pattern in the mandible as bone fracture predictor. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108:e42–51.

    Article  PubMed  Google Scholar 

  15. Verheij JG, Geraets WG, van der Stelt PF, et al. Prediction of osteoporosis with dental radiographs and age. Dentomaxillofac Radiol. 2009;38:431–7.

    Article  PubMed  CAS  Google Scholar 

  16. Jonasson G, Kiliaridis S, Gunnarsson R. Cervical thickness of the mandibular alveolar process and skeletal bone mineral density. Acta Odontol Scand. 1999;57:155–61.

    Article  CAS  Google Scholar 

  17. Cakur B, Dagistan S, Sahin A, Harorli A, Yilmaz A. Reliability of mandibular cortical index and mandibular bone mineral density in the detection of osteoporotic women. Dentomaxillofac Radiol. 2009;38:255–61.

    Article  CAS  Google Scholar 

  18. Vlasiadis KZ, Skouteris CA, Velegrakis GA, et al. Mandibular radiomorphometric measurements as indicators of possible osteoporosis in postmenopausal women. Maturitas. 2007;58:226–35.

    Article  PubMed  Google Scholar 

  19. Horner K, Karayianni K, Mitsea A, et al. The mandibular cortex on radiographs as a tool for osteoporosis risk assessment: the OSTEODENT Project. J Clin Densitom. 2007;10:138–46.

    Article  Google Scholar 

  20. Yasar F, Akgunlu F. The differences in panoramic mandibular indices and fractal dimension between patients with and without spinal osteoporosis. Dentomaxillofac Radiol. 2006;35:1–9.

    Article  PubMed  CAS  Google Scholar 

  21. Taguchi A, Ohtsuka M, Tsuda M, et al. Risk of vertebral osteoporosis in post-menopausal women with alterations of the mandible. Dentomaxillofac Radiol. 2007;36:143–8.

    Article  CAS  Google Scholar 

  22. Pluskiewicz W, Tarnawska B, Drozdzowska B. Mandibular bone mineral density measured using dual-energy X-ray absorptiometry: relationship to hip bone mineral density and quantitative ultrasound at calcaneus and hand phalanges. Br J Radiol. 2000;73:288–92.

    PubMed  CAS  Google Scholar 

  23. Binte Anwar R, Tanaka M, Kohno S, et al. Relationship between porotic changes in alveolar bone and spinal osteoporosis. J Dent Res. 2007;86:52–7.

    Article  CAS  Google Scholar 

  24. Miliuniene E, Alekna V, Peciuliene V, Tamulaitiene M, Maneliene R. Relationship between mandibular cortical bone height and bone mineral density of lumbar spine. Stomatologija. 2008;10:72–5.

    PubMed  Google Scholar 

  25. Persson GR, Berglund J, Persson RE, Renvert S. Prediction of hip and hand fractures in older persons with or without a diagnosis of periodontitis. Bone. 2011;48:552–6.

    Article  PubMed  Google Scholar 

  26. Modano DE, Irigoyen ME, Borges-Yanez A, Flores-Sanchez I, Rotter RC. Osteoporosis, the risk of vertebral fracture, and periodontal disease in an elderly group in Mexico City. Gerodontology. 2011;28:19–27.

    Article  Google Scholar 

  27. Okabe S, Morimoto Y, Ansai T, et al. Assessment of the relationship between the mandibular cortex on panoramic radiographs and the risk of bone fracture and vascular disease in 80-year olds. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106:433–42.

    Article  PubMed  Google Scholar 

  28. Takaishi Y, Ikeo T, Nakajima M, Miki T, Fujita T. A pilot case-control study on the alveolar bone density measurement in risk assessment for bisphosphonate-related osteonecrosis of the jaw. Osteoporos Int. 2010;21:815–25.

    Article  PubMed  CAS  Google Scholar 

  29. Takaishi Y, Okamoto Y, Ikeo T, et al. Correlations between periodontitis and loss of mandibular bone in relation to systemic bone changes in postmenopausal Japanese women. Osteoporos Int. 2005;16:1875–82.

    Article  PubMed  Google Scholar 

  30. Takaishi Y, Ikeo T, Miki T, Nishizawa Y, Morii H. Suppression of alveolar bone resorption by etidronate treatment for periodontal disease: 4- to 5-year follow-up of four patients. J Int Med Res. 2003;31:575–84.

    Article  PubMed  CAS  Google Scholar 

  31. Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8:1137–48.

    Article  CAS  Google Scholar 

  32. Ohishi T, Takahashi M, Kawana K, et al. Age-related changes of urinary pyridinoline and deoxypyridinoline in Japanese subjects. Clin Invest Med. 1993;16:319–25.

    PubMed  CAS  Google Scholar 

  33. Garnero P, Delmas PD. Assessment of the serum levels of bone alkaline phosphatase with a new immunoradiometric assay in patients with metabolic bone disease. J Clin Endocrinol Metab. 1993;77:1046–53.

    Article  CAS  Google Scholar 

  34. Fukunaga M, Nakamura T, Shiraki M, et al. Absolute height reduction and percent height ratio of the vertebral body in incident fracture in Japanese women. J Bone Miner Metab. 2004;22:104–10.

    Article  Google Scholar 

Download references

Acknowledgments

We thank Dr. Tim Werry, Dr. Rebecca Jackson, and Mrs. Yayoi Takaishi for editorial support in the preparation of this manuscript. No funding or sponsorship was received for this study or publication of this article. Dr. Yoshitomo Takaishi is the guarantor for this article and takes responsibility for the integrity of the work as a whole.

Conflict of interest

Dr. Yoshitomo Takaishi, Dr. Seizaburo Arita, Dr. Mitsugi Honda, Dr. Takeshi Sugishita, Dr. Aiko Kamada, Dr. Takashi Ikeo, Dr. Takami Miki, and Dr. Takuo Fujita declare no conflict of interest.

Compliance with Ethics Guidelines

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study. This study was approved by the Institutional Review Board of Katsuragi Hospital.

Author information

Authors and Affiliations

  1. Takaishi Dental Clinic, Hojo-guchi, Himeji, Japan

    Yoshitomo Takaishi & Takeshi Sugishita

  2. Department of Life and Medical Sciences, Doshisha University, Tatara, Kyotanabe, Japan

    Seizaburo Arita

  3. Department of Radiology, Okayama University Hospital, Kita-ku, Okayama, Japan

    Mitsugi Honda

  4. Department of Biochemistry, Osaka Dental University, Hanazonocho, Hirakata, Japan

    Yoshitomo Takaishi, Aiko Kamada & Takashi Ikeo

  5. Department of Geriatric Medicine, Osaka City University, Abeno-ku, Osaka, Japan

    Yoshitomo Takaishi & Takami Miki

  6. Katsuragi Hospital, Kishiwada, Japan

    Takuo Fujita

Authors
  1. Yoshitomo Takaishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seizaburo Arita
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mitsugi Honda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takeshi Sugishita
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aiko Kamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takashi Ikeo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takami Miki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takuo Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoshitomo Takaishi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Takaishi, Y., Arita, S., Honda, M. et al. Assessment of Alveolar Bone Mineral Density as a Predictor of Lumbar Fracture Probability. Adv Ther 30, 487–502 (2013). https://doi.org/10.1007/s12325-013-0028-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-013-0028-1

Keywords

Search

Navigation