Kathy R. Phipps

Determinants of bone mineral density in older men

Abstract: Although osteoporosis in men is increasingly recognized as an important health issue and bone mass appears to be a major determinant of fracture, there remain few data concerning the determinants of bone mass in men. To determine the correlates of bone density in men, we studied a large group of older subjects recruited from three rural communities in the northwestern United States. Three hundred and fifty-five men over the age of 60 years (mean 71.5 ± 7.4 years) without known disorders of mineral metabolism were recruited by community advertising. Bone mineral density was measured at the lumbar spine, proximal femur and radius by dual-energy X-ray absorptiometry, and factors potentially related to skeletal status were assessed by direct measurements or questionnaire. In univariate analyses weight (positively) and age (negatively) were associated with bone density. After adjustment for these two factors, alcohol intake, osteoarthritis and thiazide use were associated with higher bone density, while previous fractures, gastrectomy, peptic ulcer disease, rheumatoid arthritis, glucocorticoid use, hypertension, previous hyperthyroidism, height loss since age 20 years, chronic lung disease and smoking were related to lower density. In multivariate models, only weight and a history of cancer were related to higher bone mass, and age, previous fracture, rheumatoid arthritis, gastrectomy and hypertension were associated with lower density. These data contribute to the emerging field of osteoporosis in men, and may help in the clinical identification of men at higher risk of osteopenia.

Longitudinal Study of Bone Density and Periodontal Disease in Men

Bone loss is a feature of both periodontitis and osteoporosis, and periodontal destruction may be influenced by systemic bone loss. This study evaluated the association between periodontal disease and bone mineral density (BMD) in a cohort of 1347 (137 edentulous) older men followed for an average of 2.7 years. Participants were recruited from the Osteoporotic Fractures in Men Study. Random half-mouth dental measures included clinical attachment loss (CAL), pocket depth (PD), calculus, plaque, and bleeding. BMD was measured at the hip, spine, and whole-body, by dual-energy x-ray absorptiometry, and at the heel by ultrasound. After adjustment for age, smoking, race, education, body mass index, and calculus, there was no association between number of teeth, periodontitis, periodontal disease progression, and either BMD or annualized rate of BMD change. We found little evidence of an association between periodontitis and skeletal BMD among older men.

Community water fluoridation, bone mineral density, and fractures: prospective study of effects in older women

Abstract Objective: To determine whether fluoridation influences bone mineral density and fractures in older women. Design: Multicentre prospective study on risk factors for osteoporosis and fractures. Setting: Four community based centres in the United States. Participants: 9704 ambulatory women without bilateral hip replacements enrolled during 1986-8; 7129 provided information on exposure to fluoride. Main outcome measures: Bone mineral density of the lumbar spine, proximal femur, radius, and calcaneus plus incident fractures (fractures that occurred during the study) of vertebrae, hip, wrist, and humerus. Results: Women were classified as exposed or not exposed or having unknown exposure to fluoride for each year from 1950 to 1994. Outcomes were compared in women with continuous exposure to fluoridated water for the past 20 years (n=3218) and women with no exposure during the past 20 years (n=2563). In women with continuous exposure mean bone mineral density was 2.6% higher at the femoral neck (0.017 g/cm2, P<0.001), 2.5% higher at the lumbar spine (0.022 g/cm2, P<0.001), and 1.9% lower at the distal radius (0.007 g/cm2, P=0.002). In women with continuous exposure the multivariable adjusted risk of hip fracture was slightly reduced (risk ratio 0.69, 95% confidence interval 0.50 to 0.96, P=0.028) as was the risk of vertebral fracture (0.73, 0.55 to 0.97, P=0.033). There was a non-significant trend toward an increased risk of wrist fracture (1.32, 1.00 to 1.71, P=0.051) and no difference in risk of humerus fracture (0.85, 0.58 to 1.23, P=0.378). Conclusions: Long term exposure to fluoridated drinking water does not increase the risk of fracture.

Prevalence and severity of dental caries among American Indian and Alaska Native preschool children

OBJECTIVES To describe the Indian Health Service (IHS) oral health surveillance system and the oral health status of American Indian and Alaska Native (AI/AN) children aged 1-5 years. METHODS A stratified probability sample of IHS/tribal sites was selected. Children were screened by trained examiners at community-based locations including medical clinics, Head Start, preschools, kindergarten, and Women, Infants, and Children (WIC). Data collection was limited to the primary dentition and included number of teeth present plus number of teeth with cavitated lesions, restorations, and extracted because of decay. Number of molars with sealants and urgency of need for dental care data were also obtained. Statistical analyses were performed with SAS (SAS Institute Inc., Cary, NC, USA). Sample weights were used to produce population estimates based on selection probabilities. RESULTS A total of 8,461 AI/AN children 12-71 months of age were screened at 63 IHS/tribal sites, approximately 7 percent of the estimated IHS user population of the same age. Overall, 54 percent of the children had decay experience, 39 percent had untreated decay, 7 percent had primary molar sealants, 36 percent needed early or urgent dental care, and 6 percent needed urgent dental care. The mean of decayed, missing, or filled teeth was 3.5 (95 percent confidence interval, 3.1-3.9). The prevalence of decay experience increased with age; 21 percent of 1-year-olds and 75 percent of 5-year-olds had a history of caries. When stratified by IHS area, there were substantial differences in the oral health of preschool children. CONCLUSIONS The results confirm that in the United States, AI/AN children served by IHS/tribal programs are one of the racial/ethnic groups at highest risk of caries.

Periodontal Conditions in Elderly Men With and Without Osteoporosis or Osteopenia

BACKGROUND The purpose of this case-control study is to investigate the periodontal conditions in elderly men with and without osteoporosis or osteopenia and to determine their possible association with periodontal destruction. METHODS A total of 200 community-dwelling Chinese males (age range: 69 to 78 years; mean ± SD age: 71.9 ± 3.3 years) were recruited from the Jockey Club Center for Osteoporosis Care and Control, The Chinese University of Hong Kong, including 67 subjects with osteoporosis, 66 subjects with osteopenia, and 67 age-matched normal control subjects based on bone mineral density at the hip, spine, and whole body measured by dual-energy x-ray densitometry. All subjects were interviewed using questionnaires and received a full-mouth periodontal examination. RESULTS Subjects with osteoporosis exhibited a significantly higher percentage of sites with clinical attachment loss (AL) > or= 6 mm compared to subjects with osteopenia (P <0.05); subjects with osteoporosis also showed a greater percentage of sites with interproximal gingival recession (GR) > or = 5 mm than did control subjects (P <0.05) after excluding smokers. Subjects with osteoporosis were more likely (odds ratio = 3.3; P <0.05) to exhibit interproximal GR > or = 5 mm than were control subjects. Osteoporosis remained significantly associated with severe clinical AL and interproximal GR after adjusting for age, supragingival plaque, and number of teeth lost. CONCLUSION This study suggests that osteoporosis is associated with severe clinical AL and interproximal GR in elderly Chinese men.

Sex Steroids, Periodontal Health, and Tooth Loss in Older Men

Sex steroids have a significant effect on skeletal biology in men, with reduced levels being associated with lower skeletal bone mass and cortical thickness. The purpose of this study was to determine if sex steroids are associated with periodontitis and tooth loss in a cohort of 1210 older dentate men followed for 3 years. Periodontal measures included attachment loss, pocket depth, gingival bleeding, and number of teeth. Baseline serum testosterone and estradiol were measured by radioimmunoassay. Severe periodontitis was common at baseline (38%), and progression occurred in 32% of the cohort. Incident tooth loss occurred in 22% of the cohort. Testosterone, estradiol, and sex hormone binding globulin (SHBG) concentrations were not related to baseline periodontal status or number of teeth. Moreover, there was no relationship between sex steroid levels and periodontitis progression or incident tooth loss. Although periodontitis, progression of periodontitis, and tooth loss are common in older men, they were not associated with sex steroids.

Effects of Life-long Fluoride Intake on Bone Measures of Adolescents: A Prospective Cohort Study

Controversy persists concerning the impact of community water fluoridation on bone health in adults, and few studies have assessed relationships with bone at younger ages. Ecological studies of fluoride’s effects showed some increase in bone mineral density of adolescents and young adults in areas with fluoridated water compared with non-fluoridated areas. However, none had individual fluoride exposure measures. To avoid ecological fallacy and reduce bias, we assessed associations of average daily fluoride intake from birth to age 15 yr for Iowa Bone Development Study cohort members with age 15 yr dual-energy x-ray absorptiometry (DXA) bone outcomes (whole body, lumbar spine, and hip), controlling for known determinants (including daily calcium intake, average daily time spent in moderate-to-vigorous intensity physical activity, and physical maturity). Mean (SD) daily fluoride intake was 0.66 mg (0.24) for females and 0.78 mg (0.30) for males. We found no significant relationships between daily fluoride intake and adolescents’ bone measures in adjusted models (for 183 females, all p values ≥ .10 and all partial R2 ≤ 0.02; for 175 males, all p values ≥ .34 and all partial R2 ≤ 0.01). The findings suggest that fluoride exposures at the typical levels for most US adolescents in fluoridated areas do not have significant effects on bone mineral measures.

Periodontal health of older men: the MrOS dental study.

OBJECTIVE The purpose of this study was to evaluate the prevalence and severity of periodontitis in men of 65+ years and identify demographic and lifestyle factors associated with its presence. METHODS Participants were recruited from the Osteoporotic Fractures in Men Study, a longitudinal study of risk factors for fractures in older men. Dental measures included clinical attachment loss (CAL), pocket depth (PD), calculus, plaque and bleeding on a random half-mouth, plus a questionnaire regarding access to care, symptoms and previous diagnosis. RESULTS 1210 dentate men completed the dental visit. Average age was 75 years, 39% reported some graduate school education, 32% smoked 20 + pack years and 88% reported their overall health as excellent/good. In terms of periodontal health, 38% had sub-gingival calculus, 53% gingival bleeding, 82% CAL > or =5 mm and 34% PD > or =6 mm. The prevalence of severe periodontitis was 38%. Significant demographic and lifestyle factors associated with severe periodontitis in multivariate analyses included age > or =75 (OR 1.4, 95% CI 1.1-1.7) non-white race (OR 1.9, 95% CI 1.3-2.8), less than an annual dental visit (OR 1.5, 95% CI 1.1-2.0), and 20 + pack years (OR 2.1, 95% CI 1.6-2.7). CONCLUSION A high proportion of healthy older men have evidence of periodontal destruction which could, given the growing ageing population, have a significant impact on the dental professions ability to provide preventive and therapeutic care. The population at highest risk of periodontitis in MrOS is older minority men who smoke and do not have annual dental visits.

Factors associated with dental caries in a group of American Indian children at age 36 months

OBJECTIVES Early childhood caries (ECC) is rampant among American Indian children, but there has been relatively little study of this problem. This article reports on risk factors for caries for a group of American Indian children at age 36 months as part of a longitudinal study. METHODS Pregnant women from a Northern Plains Tribal community were recruited to participate in a longitudinal study of caries and caries risk factors. Standardized dental examinations were completed on children, and questionnaires were completed by mothers at baseline and when children were 4, 8, 12, 16, 22, 28, and 36 months of age. Examinations were surface-specific for dental caries, and the questionnaires collected data on demographic, dietary, and behavioral factors. Nonparametric bivariate tests and logistic regression models were used to identify risk factors for caries at 36 months, and negative binomial regression was used to identify factors related to caries severity (dmf counts). RESULTS Among the 232 children, and caries prevalence for cavitated lesions was 80%, with an additional 15% having only noncavitated lesions. The mean dmfs was 9.6, and of the total dmfs, nearly 62% of affected surfaces were decayed, 31% were missing, and 7% were filled. Logistic regression identified higher added-sugar beverage consumption, younger maternal age at baseline, higher maternal DMFS at baseline, and greater number of people in the household as significant (P < 0.05) risk factors. Negative binomial regression found that only maternal DMFS was associated with child dmf counts. CONCLUSIONS By the age of 36 months, dental caries is nearly universal in this population of American Indian children. Caries risk factors included sugared beverage consumption, greater household size, and maternal factors, but further analyses are needed to better understand caries in this population.

Relationship of Bone Metabolism Biomarkers and Periodontal Disease: The Osteoporotic Fractures in Men (MrOS) Study.

CONTEXT Periodontitis is an inflammatory disease of tooth-supporting tissue leading to bone destruction and tooth loss. Periodontitis affects almost 50% of adults greater than 30 years of age. OBJECTIVE This study evaluated the association between biomarkers linked to bone formation and resorption with the occurrence and progression of periodontal disease in older men (≥ 65 y). DESIGN The Osteoporotic Fractures in Men (MrOS) study is a prospective, observational study among men 65 years of age and older. SETTING This ancillary study, Oral and Skeletal Bone Loss in Older Men, was conducted at two of the six MrOS study sites (Birmingham, AL and Portland, OR). PATIENTS Patients underwent medical and dental evaluation. Diagnoses of periodontitis were based on clinical attachment loss, pocket depth, calculus, plaque, and bleeding on a random half-mouth. Bone metabolism biomarkers included serum levels of calcium, phosphate (Pi), alkaline phosphatase, albumin, carboxy-terminal collagen crosslinks (CTX), N-terminal propeptides of type I procollagen, isoform 5b of tartrate-resistant acid phosphatase, and urine alpha- carboxy-terminal collagen crosslinks (alpha-CTX) and beta-CTX and serum levels of calciotropic hormones vitamin D (25(OH)D) and PTH. MAIN OUTCOME MEASURES The aim of this study is to correlate bone metabolism biomarkers with prevalence and progression of periodontal disease in older men. RESULTS Patients with more severe periodontitis had significantly higher levels of PTH (P trend = .0004), whereas 25(OH)D was lower (P trend = .001). In a subset of men reevaluated at a second dental visit, improvement of periodontitis was associated with lower alpha-CTX, beta-CTX, and CTX levels at baseline after adjusting for age, site, and body mass index. CONCLUSION This study suggests that a distinct set of biomarkers of bone metabolism are associated with more severe periodontal disease (PTH, 25(OH)D) and periodontal progression (alpha-CTX, beta-CTX, and CTX) over time.