Postmenopausal osteoporosis and tooth loss.
ABSTRACT The aim of this study was to determine relation between tooth loss and general body bone mineral density in postmenopausal female who were seeking for prosthetic treatment.
There were included 79 women in this study (age from 49-81 years, mean age 62.9 years) with partial tooth loss. For all patients bone mineral density measurements for lumbar spine and both femoral necks by dual energy X-ray absorptiometry (Lunar DEXA DPX-NT, GE Medical Systems) were performed. Based on DEXA results patients were divided into 3 groups: normal bone density (T-score ≥-1.0), osteopenia (T-score from -1.0 till -2.5) and osteoporosis (T-score ≤-2.5). Dental investigation was performed to detect existing teeth. ANOVA analysis of variance was used to determine relationship between different variables by group. To test correlation between different values Pearson correlation was used.
The number of teeth in different bone mineral density groups is almost similar. There are no statistically significant differences between groups according the number of the all teeth present and according the number of teeth in maxilla and mandible. There is no significant correlation between the number of the teeth and DEXA readings, except there is weak correlation between the number of maxillary posterior teeth and bone mineral density in femoral neck.
There is no correlation between number of the teeth and general bone mineral density.
92 Stomatologija, Baltic Dental and Maxillofacial Journal, 2011, Vol. 13, No. 3
Stomatologija, Baltic Dental and Maxillofacial Journal, 13:92-5, 2011
Objective. The aim of this study was to determine relation between tooth loss and general body
bone mineral density in postmenopausal female who were seeking for prosthetic treatment.
Material and methods. There were included 79 women in this study (age from 49-81 years,
mean age 62.9 years) with partial tooth loss.
For all patients bone mineral density measurements for lumbar spine and both femoral necks by
dual energy X-ray absorptiometry (Lunar DEXA DPX-NT, GE Medical Systems) were performed.
Based on DEXA results patients were divided into 3 groups: normal bone density (T-score ≥-1.0),
osteopenia (T-score from -1.0 till -2.5) and osteoporosis (T-score ≤-2.5).
Dental investigation was performed to detect existing teeth.
ANOVA analysis of variance was used to determine relationship between different variables
by group. To test correlation between different values Pearson correlation was used.
Results. The number of teeth in different bone mineral density groups is almost similar. There
are no statistically significant differences between groups according the number of the all teeth pres-
ent and according the number of teeth in maxilla and mandible. There is no significant correlation
between the number of the teeth and DEXA readings, except there is weak correlation between the
number of maxillary posterior teeth and bone mineral density in femoral neck.
Conclusion. There is no correlation between number of the teeth and general bone mineral density.
Key words: bone mineral density, menopause, osteoporosis, tooth loss.
Postmenopausal osteoporosis and tooth loss
Anda Slaidina, Una Soboleva, Ilze Daukste, Agnis Zvaigzne, Aivars Lejnieks
1Department of Prosthodontics, Riga Stradins University, Latvia
2Riga Second Hospital, Riga, Latvia
3Clinics of Internal Diseases, Paul Stradins Clinical University
4Department of Internal Diseases, Riga Stradins University, Latvia
5Riga Austrumu Clinical University Hospital
Anda Slaidina1 – D.D.S., PhD, instructor
Una Soboleva1 – D.D.S., PhD, assoc. prof.
Ilze Daukste2 – M.D.
Agnis Zvaigzne3, 4 – M.D., PhD, assist. prof.
Aivars Lejnieks3, 5 – M.D., PhD, prof.
Address correspondence to Dr. Anda Slaidina, Department of
Prosthodontics, Institute of Stomatology, Riga Stradins university,
20 Dzirciema str., Riga LV-1007, Latvia.
E-mail address: email@example.com
Osteoporosis is a systemic disease characterized by
decreased bone mineral density, impaired microarchitec-
ture leading to the loss of bone strength and consequent
increase of bone fracture risk [1; 2]. It is very common
disease among populations in moderate climate zone
around the world, and it is directly connected with age.
According to the data of the World Health Organisation
osteoporosis is the second most common disorder fol-
lowing cardiovascular diseases , and fractures caused
by it are observed in every third female and every fifth
male older than 50 years . Although this disease is
observed among females and males, the most common
type in 90% of cases is postmenopausal osteoporosis
. Due to ageing of the European population number
of patients with osteoporosis will double in the next 50
years . Experts estimated that in Latvia 160 000 –
200 000 females 45-80 years of the age may have
osteopenia or osteoporosis . Osteoporosis involves
jaw bones similarly as the rest of skeleton . The ef-
fect of osteoporosis on jaw bones and related structure
nowadays is widely studied [8-10]. There is an opinion
that females with low bone mineral density have a
higher rate of tooth loss. However, research findings are
controversial [11-13]. Since the rate of tooth loss among
Latvian population is higher than European average this
issue becomes very important [14; 15].
The aim of the study was to determine relation
between tooth loss and general body bone mineral
density in postmenopausal female who were seeking
for prosthetic treatment.
MATERIAL AND METHODS
The study population included 79 postmenopausal
patients aged 49-81 (mean age 62.9 years) from the
Stomatologija, Baltic Dental and Maxillofacial Journal, 2011, Vol. 13, No. 3 93
by group. Pearson correlation was used to determine
correlation between different variables.
The number of females included in this study
was 96 and 79 of them (82.29%) agreed to participate
and had all necessary examinations. According to the
DEXA results all females were dividend into 3 groups:
females with normal bone mineral density – 25 (mean
age 61.56±9.8 years), females with osteopenia – 36
(mean age 62.17±8.54 years), and females with os-
teoporosis – 18 (mean age 66.22±9.47 years). The
age differences between groups were not statistically
The number of preserved teeth in different groups
(normal bone mineral density, osteopenia and osteopo-
rosis) was almost similar. There were no statistically
significant differences between groups in respect to the
total number of teeth (p=0.9926), and number of teeth in
maxilla (p=0.9064) and mandible (p=0.6821) (Table 1).
No correlation between number of teeth and DEXA
readings was found (Table 2). Weak correlation was
observed between number of maxillary posterior teeth
and bone mineral density in femoral neck (Table 3).
The prevalence of various age related diseases as
well as research relating to these diseases increases due
to ageing of population. Therefore, osteoporosis and its
side effects also becomes very important topic nowa-
days. The research in dentistry is focused on effects of
osteoporosis on various structures of oral cavity, includ-
ing periodontal structures and alveolar bone. Although
findings of studies are controversial several studies have
found that females with osteoporosis more frequently
have a periodontal disease with more severe symptoms
[16-18]. It suggests that individuals with low bone
mineral density have a higher rate of tooth loss which
is supported also by studies [11; 13; 19]. Inagaki et al
proposed theory that in the studies where relationship
between osteoporosis and tooth loss was not found the
age of patients was too low (females younger than 60
SCIENTIFIC ARTICLES A. Slaidina et al.
Prosthetic Clinic of the Institute of Stomatology with
partial adentia, who attended clinic during the time
period September 2008 – December 2008 and agreed
to participate. Study protocol was reviewed and per-
mission was obtained from the Ethics Commission of
Riga Stradins University.
The study was designed as cohort study. We asked
to participate in the study all female who attended the
Prosthetic clinic in particular time period. Overall 96
females were asked to take part in this study, and 12
of them refused to participate due to lack of time and
other reasons. Five females were excluded from the
study due to missing bone mineral density examina-
Patients with the history of thyroid disease, im-
paired calcium metabolism, hyperthyroidism, diabetes
mellitus, long term use of glucocorticoids and other
diseases affecting bone metabolism were excluded
from the study. Smokers and patients with alcohol
abuse were excluded from the study. Patients with ag-
gressive periodontitis and those who didn’t cooperate
were exclude from study
Number of the existing teeth was determined dur-
ing the clinical examination of the oral cavity.
As patients were in different treatment stages for
periodontal and caries treatment, we couldn’t control
these variables, therefore we decide not to perform
additional periodontal or caries examination.
All patients underwent dual energy X-ray absorp-
tiometry (DEXA) (Lunar DEXA DPX-NT, GE Medi-
cal Systems – Riga Hospital No 2) to determine bone
mineral density. This examination was performed for
lumbar spine (L2-L4) and femoral neck. All examina-
tions were performed by one experienced professional.
The worst T-score reading (L2-L4 and femoral neck)
was taken into consideration. Patients were divided into
3 groups according to the WHO criteria: normal bone
mineral density (T-score – +2,5 to -1), osteopenia (T-
score <-1,0 to -2,5), osteoporosis (T-score ≤ -2,5) .
Data was analyzed using descriptive and analyti-
cal statistical methods. Distribution of values by dif-
ferent groups was determined using 2×2 and r×c fre-
quency tables. ANOVA analysis of variance was used
to determine relationship between different variables
Table 1. The number of the teeth by different groups of bone mineral density
94 Stomatologija, Baltic Dental and Maxillofacial Journal, 2011, Vol. 13, No. 3
Table 2. Correlations and correlation coefficients between number of teeth and DEXA
Table 3. Correlations and correlation coefficients between number of teeth in frontal
and posterior region and DEXA readings
Total number of
Lumbar spine (L2-L4) -0.08
Worst reading from
femoral neck and
Lumbar spine (L2-L4) -0.107
Worst from femoral
neck and lumbar spine
A. Slaidina et al. SCIENTIFIC ARTICLES
 and peripheral DEXA  are good methods for
osteoporosis screening, which are not accurate enough
for diagnosis of osteoporosis, are also used. DEXA
examination, which is the main diagnostic method
worldwide, was used for diagnosis of osteoporosis in
our study. Main advantages are as follows: it is rela-
tively cheap method, easy to use, with low radiation
dose and good accuracy (error 0.9-5%) . However,
it does not provide information regarding dimensional
bone structure and bone microarchitecture. Since it
is difficult to compare results obtained with various
DEXA devices , we used only one device and all
measurements were made by one experienced profes-
sional in order to reduce inaccuracy of DEXA readings.
One of the study limitations is population chosen,
which includes patients of the Prosthodontic clinic
mainly attending clinic to replace lost teeth. The rate
of tooth loss in these patients probably is higher than
in general population. In order to diminish this effect
we excluded from the study all edentulous females.
Main reasons for the teeth loss are caries, periodontal
diseases and complications. Some previous studies have
shown that females with osteoporosis more frequently
have a periodontal disease with more severe symptoms
[16-18]. It could cause tooth loss, therefore reason for
tooth loss becomes very important research question.
Unfortunately in present study it
is impossible to control cause of
tooth loss in long term and dental
situation at present not always
represent tooth loss reason in
past, therefore we didn’t take it
The prevalence and inci-
dence of caries among children
and adults in Latvia is high .
The aetiology of caries is more
related to the plaque and carbo-
hydrate rich diet . Due to
socioeconomic reasons people
often choose tooth extraction as
a treatment method. This is the
possible reason why we didn’t
find relationship between osteo-
porosis and tooth loss. Similar
conclusion was made also by
Klemmenti and Vainio, who
observed similar problem in Fin-
land where intensity of caries and
loss of teeth was very high .
Osteoporosis primarily af-
fects trabecular bone and later
cortical bone . Since maxilla
contains more cortical bone os-
years of age), and it means that osteoporosis was pres-
ent not long enough for negative effect to manifest in
the jaw bones . Yet, Taguchi et al observed positive
relationship between osteoporosis and tooth loss also
among relatively young females [11; 20] and May and
Weyant et al didn’t find such relationship among elderly
females [21; 22]. The findings of the present study are
similar. Although the mean age of females was 62.9
years, females with decreased bone mineral density had
no higher rate of tooth loss which is in compliance with
many other studies [12; 23; 24].
Though age is an important risk factor for devel-
opment of osteoporosis, we didn't find any statistically
significant difference between osteoporosis, osteopenia
and normal bone mineral density by age groups. It may be
explained by small study population. It suggests that we
can exclude age of patients as a confounding factor which
has a high correlation with the number of lost teeth .
It is difficult to compare various studies regarding
the effect of osteoporosis on tooth loss because they
all have different design and they all employ different
methods for diagnosis of osteoporosis. In some studies
history of osteoporotic fractures  and x-rays 
are used for diagnosis of osteoporosis. It does not ex-
clude cases when females without fractures do not have
low bone mineral density. Qualitative ultrasound scan
Stomatologija, Baltic Dental and Maxillofacial Journal, 2011, Vol. 13, No. 3 95
trabecular bone and first changes of bone mineral den-
sity are observed in vertebral column, and only later
in hips, the findings of our study suggests, that there
might be a lag time between decreased bone mineral
density and tooth loss.
Postmenopausal females who were seeking for
prosthetic treatment and had low bone mineral density
does not have higher rate of tooth loss than postmeno-
pausal females with normal bone mineral density.
SCIENTIFIC ARTICLES A. Slaidina et al.
teoporosis affects maxilla at first especially posterior
region where bone density is already anatomically low-
er . However, we didn't find relationship between
number of maxilla teeth and bone mineral density.
During separate examination of frontal and posterior
teeth we observed slight correlation between number of
maxillary posterior teeth and hip bone mineral density.
In the study performed in Japan, where mean age of
females was 54 years, number of posterior teeth was
associated with the 3rd lumbar vertebral bone mineral
density , however they didn’t evaluate hip bone
mineral density. Since osteoporosis primary affects
1.? Peck WA, Burkhard P, Christensen C. Consensus develop-
ment Conference: diagnosis, prophylaxis and treatment of
osteoporosis. Am J Med 1993;94:645-50.
2.? NIH Consensus Development Panel on Osteoporosis preven-
tion, diagnosis and therapy. JAMA 2001;285:785-95.
3.? WHO. Assessment of fracture risk and its application to scree-
ning for postmenopausal osteoporosis: Report of WHO Study
Group. World Health Organ Tech Rep Ser;843.WHO; 1994.
4.? Melton LJ, Chrischilles EA, Cooper C, Lane AW, Riggs BL.
Perspective: How many women have osteoporosis? J Bone
Miner Res 1992;7:1005-10.
5.? Albright F, Smith PH, Richardson AM. Post-menopausal
osteoporosis. Its clinical features. JAMA 1941;116:2465-74.
6.? Lejnieks A. Osteoporozes diagnostika, profilakses un ārs-
tēšanas vadlīnijas (Guidelines of osteoporosis diagnosis,
prophylaxis and treatment). Riga, Latvia; 2005.
7.? Von Wowern N. General and oral aspects of osteoporosis: a
review. Clin Oral Investig 2001;5:71-82.
8.? Miliuniene E, Alekna V, Peciuliene V, Tamulaitiene M, Mane-
liene R.Relationship between mandibular cortical bone height
and bone mineral density of lumbar spine. Stomatologija.
Baltic Dent Maxillofac J 2008;10:72-5.
9.? Ozola B, Slaidina A, Laurina L, Soboleva U, Lejnieks A.
The influence of bone mineral density and body mass index
on resorption of edentulous jaws. Stomatologija. Baltic Dent
Maxillofac J 2011;13:19-24.
10.?Peciuliene V, Maneliene R, Balcikonyte E, Drukteinis S, Rut-
kunas V. Microorganisms in root canal infections: a review.
Stomatologija. Baltic Dent Maxillofac J 2004;6:17-19.
11.?Taguchi A, Suei Y, Ohtsuka M, Otani K, Tanimoto K, Hol-
lender LG. Relationship between bone mineral density and
tooth loss in elderly Japanese women. Dentomaxillofac Radiol
12.?Earnshaw SA, Keatign N, Hosking DJ. Tooth counts do not
predict bone mineral density in early postmenopausal Cauca-
sian women. Int J Epidemiol 1998;27:479-83.
13.?Meisel P, Reifenberger J, Haase R, Nauck M, Bandt C, Kocher
T. Women are periodontally healthier than men, but why don't
they have more teeth than men? Menopause 2008;15:270-75.
14.?Soboleva U, Rogovska I, Pugaca J. Assessment of the received
prosthetic treatment in the Latvian population. Stomatologija.
Baltic Dent Maxillofac J 2006; Suppl 3: 39.
15.?Care R, Arne G. Kariesa intensitāte Latvijā 2005. gadā
pieaugušajiem iedzīvotājiem 35-44 un 65-74 gadu vecuma
grupās (Caries intensity in age groups 35-44 and 56-74 years
in Latvia). RSU Zinātniskie raksti 2007. p. 340-4.
16.?Ingaki K, Kurosu Y, Yoshinari N, Noguchi T, Krall EA, Garcia
RI. Efficacy of periodontal disease and tooth loss to screen for
low bone mineral density in Japanese women. Calcif Tissue
Int 2005;77: 9-14.
17.?Persson RE, Hollender LG, Powell LV, MacEntee MI, Wyatt
CC, Kiyak HA, et al. Assessment of periodontal conditions and
systemic disease in older subjects. I. Focus on osteoporosis.
J Clin Periodontol 2002;29:796-802.
18.?Tezala M, Wactawski- Wende J, Grossi SG, Ho AW, Dunford
R, Genco RJ. The relationship between bone mineral density
and periodontitis in postmenopausal women. J Periodontol
19.?Bando K, Nitta H, Matsubara M, Ishikawa I. Bone mineral
density in periodontally healthy and edentulous postmeno-
pausal women. Ann Periodontol 1998;3:322-6.
20.?Taguchi A, Tanimoto K, Suei Y, Otani K, Wada T. Oral signs
as indicators of possible osteoporosis in elderly women. Oral
Surg Oral med Oral Pathol Oral Radiol Endod 1995;80:
21.?May H, Reader R, Murphy S, Khaw KT. Self-reported tooth
loss and bone mineral density in older men and women. Age
22.?Weyant RJ, Pearlstein ME, Churka AP, Forrest K, Famili P,
Cauley JA. The association between osteopenia and peri-
odontal attachment loss in older women. J Periodontol
23.?Hildebolt CF, Pilgram TK, Dotson M, Yokoyama-Crothers N,
Muckerman J, Hauser J, et al. Attachment loss with postmeno-
pausal age and smoking. J Periodontal Res 1997;32:619-25.
24.?Kribbs PJ, Chesnut CH, Ott SM, Kilcoyne RF. Relationship
between mandibular and skeletal bone in a population of
normal women. J Prosth Dent 1990;63:86-9.
25.?Madlena M, Hermann P, Jahn M, Fejerdy P. Caries prevalence
and tooth loss in Hungarian adult population: results of a
national survey. BMC Public Health 2008;8:364.
26.?Astrom J, Backstrom C, Thidevall G. Tooth loss and hip
fractures in the eldery. J Bone Joint Surg (Br) 1990;72:324-5.
27.?Yoshihara A, Seida Y, Hanada N, Nakashima K, Miyazaki H.
The relationship between bone mineral density and the number
of remaining teeth in community-dwelling older adults. J Oral
28.?Kanis JA, Melton LJ, Christiansen C. The diagnosis of osteo-
porosis. J Bone Miner Res 1994;9:1137-41.
29.?Wilson CR, Fogelman I, Blake GM, Rodin A. The effect of
positioning on dual energy X-ray bone densitometry of the
proximal femur. J Bone Mineral 1991;13:69-76.
30.?Moore WJ. The role of sugar in the aetiology of dental
caries. 1. Sugar and the antiquity of dental caries. J Dent
31.?Klemetti E, Vainio P. Effect of bone mineral density in skel-
eton and mandible on extraction of teeth and clinical alveolar
height. J Prosthet Dent 1993;69: 21-5.
32.?Stevenson JC, Banks LM, Spinks TJ, Freemantle C, MacIntyre
I, Hesp R, et al. Regional and total skeletal measurements
in the early postmenopause. J Clin Invest 1987;80:258-62.
33.?August M, Chung K, Chang Y, Glowacki J. Influence of es-
trogen status on endosseous implant osseointegration. J Oral
Maxillofac Surg 2001;59:1285-9.
Received: 06 07 2010
Accepted for publishing: 23 09 2011