Osteoporosis: are the treatments bad for the teeth?

Reduction in height, intense pain in the back…a so-called “silent” disease, osteoporosis is nonetheless a real problem for many people over the age of 65. Bone affliction linked to aging, it is characterized by a decrease in bone density and changes in its microarchitecture. The bone is more fragile and the risk of fracture increases. Among the factors involved in the regulation of bone mass, vitamin D but especially sex hormones. The disease is particularly connected to hormonal changes linked to menopause and although it can also affect men, it is especially prevalent in postmenopausal women. To give an idea in terms of figures, in Europe and the United States, 30% of postmenopausal women have osteoporosis.

In some, the loss of bone mass will not have serious consequences, but in others, the abnormal acceleration of bone resorption not compensated by sufficient bone formation will lead to excessive loss of bone mass and strength. This is then called osteoporosis. When the disease begins, the doctor first treats a possible deficiency in vitamin D and or calcium, in particular by encouraging his patient to change his diet. It also encourages him to do more physical activity, to reduce his alcohol and salt consumption and to quit smoking if he is a smoker. But if the disease is confirmed and worsens, he can prescribe different drugs. Among them, bisphosphonates. Some having associated these with a fall of the teeth, Why Doctor today takes stock.

“There are data showing a certain parallelism between the probability of having osteoporosis and the loss of teeth”, explains Bernard Cortet, rheumatologist at the Lille University Hospital to Why Doctor. Overall, patients suffering from osteoporosis therefore have every interest in taking the greatest possible care of their oral hygiene and in consulting their dental surgeon regularly. But the biggest problem comes from certain treatments: bisphosphonates which can lead to a serious complication: osteonecrosis of the jaw”, continues the expert. This phenomenon may be extremely rare (one person in 10,000 is affected), “sometimes there is confusion in the minds of patients who think that osteoporosis treatments can be harmful to teeth, which of course is not the case.” Bernard Cortet therefore encourages patients to carry out an oral check-up before starting treatment.

Some dentists continue to advise against osteoporosis treatments

“There are no jaw fractures related to osteoporosis and we don’t have a lot of specific data on the impact of treatments on the jaw,” he insists. The alveolar bone, which supports the teeth, is itself susceptible to ageing, to hormonal factors but above all to local factors such as chewing and of course the underlying condition of the teeth. This is why, here again, a diet richer in vitamin D is to be recommended. It will undoubtedly be, in addition to being positive for the skeleton, beneficial to the patient’s teeth.

But if the data show no particular risk, why do dentists continue to advise against certain osteoporosis treatments? “There is some confusion in the minds of dentists between these bisphosphonates used in people with osteoporosis and bisphosphonates which can be prescribed in much sicker people who have bone cancer. Some similar molecules are used in both cases but the quantity is much higher in the field of bone metastases”indicates Bernard Cotet. “The real problem with osteonecrosis of the jaw is when you have bone metastases.” The frequency of this phenomenon is then much higher, since it affects 1%, even 10% of patients. As for dental extractions, it is quite possible to perform them when you suffer from osteoporosis and are treated with bisphosphonates, assures the specialist.

Establish a dialogue rheumatologist, dentist, patient

Unfortunately, many dentists believe that this treatment is too dangerous. This is why a dialogue must be established between the practitioner, the patient and the rheumatologist who prescribes the treatment. “When the patient really has a very high risk of fracture, I think it’s important to start treatment very quickly. On the other hand, when it’s less urgent, when it’s only densitometric osteoporosis by example, it is reasonable to carry out the dental care at its term”specifies Bernard Cortet.

In conclusion, “There is a parallelism between having osteoporosis and premature tooth loss, although there is no data to prove this link.” it is therefore necessary to make an oral check-up before the establishment of treatment with bisphosphonates, he recommends. “But you have to know reason to keep and, if the fracture risk is very high, consider starting treatment before starting dental treatment.”