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 During menopause and afterward, the body slows production of new
bone tissue and women face an increased risk of osteoporosis.
Falling levels of the hormone estrogen around menopause can
contribute to fragile, brittle bones associated with both
osteoporosis and periodontal disease, or infections around the teeth
and gums.
For the current study, researchers examined data on 492 women in
Bahia, Brazil, who had gone through menopause and had bone density
scans between 2009 and 2011. The group included 113 women treating
osteoporosis with calcium and vitamin D supplements, or with
estrogen alone or in combination with the hormone progestin.
Overall, the rate of severe periodontitis - when the inner layer of
gums pull away from the teeth - was 44 percent lower among the women
taking estrogen for osteoporosis, the study found.
“I imagine that a patient who forgoes osteoporosis treatment with
estrogen because of its risks is unlikely to change her mind after
learning there is a potential connection to periodontal disease,”
said Natalia Chalmers, director of analytics at the DentaQuest
Institute in Westborough, Massachusetts.
“But if she is already predisposed to severe periodontitis, it is
important for her to know how osteoporosis may make her condition
worse,” Chalmers, who wasn’t involved in the study, said by email.
Risks of estrogen therapy can include increased odds of heart
disease and breast cancer, Johelle de S. Passos-Soares of the
Federal University of Bahia in Brazil and colleagues note in the
Journal Menopause. Passos-Soares didn’t respond to requests for
comment on the study.
Periodontitis is a leading cause of tooth loss in older adults. As
gums pull away from the teeth, debris collects in the mouth that can
become infected and plaque can spread below the gum line. In severe
cases so much gum tissue and bone are destroyed that teeth become
loose and fall out.
Women in the study were 61 years old on average, and ranged in age
from 50 to 87. They typically when through menopause when they were
around 47 years old.
Women treating osteoporosis averaged about 9 missing teeth, 8
decayed teeth and 2 teeth with fillings or restorations. They were
also more likely than women not treating osteoporosis to have
visited a dentist within the past two years.
With estrogen treatments, fewer women had periodontal disease, which
researchers defined as gaps at least 5 millimeters deep between the
gums and the jaw around at least 30 percent of teeth. But the
difference from women not using estrogen was too small to rule out
the possibility that it was due to chance.
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However, osteoporosis treatment was associated with fewer cases of
severe periodontitis and significantly fewer teeth that had gaps at
least 4 millimeters deep between the gums and the teeth.
The study isn’t a controlled experiment designed to show whether
estrogen treatment after menopause directly prevents gum disease or
severe periodontitis.
Limitations of the study include the fact that researchers looked at
women at a single point in time, so they couldn’t determine when the
women developed oral health problems relative to when they went
through menopause or started estrogen treatments. Women in the study
were also recruited from a health center, making it possible the
findings might be different in a broader population of patients,
researchers note.
It’s also possible that women who seek routine care for one aspect
of their health may be more likely to get treatment for other health
issues, Chalmers said. That means the connection between
osteoporosis treatment and women seeking more preventive care in
general might explain a lower risk of periodontal disease.
“The link between osteoporosis and periodontal disease is not clear,
and more studies are needed to fully assess this connection,”
Chalmers said. “However, we can say that patients affected by each
condition share risk factors such as age, smoking, hormonal change
and genetics, as well as calcium and vitamin D deficiency.”
SOURCE: http://bit.ly/2oykoJb Menopause, online February 22, 2017.
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