(literally means porous bones)

Osteoporosis is a
medical condition in
which the bones become
brittle and fragile from
loss of tissue, typically as
a result of hormonal
changes, or deficiency of
calcium or vitamin D.

 Some osteoporosis risk factors include gender, age and

family history.
Other lifestyle risk factors include tobacco use, alcohol
consumption, diet and activity level.
The International Osteoporosis Foundation states that 1 in 3
women and 1 in 5 men are at risk for an osteoporosis related
fracture.
Osteoporosis most often affects the elderly, but it starts to
develop at a much younger age.
The choices we make during our peak years of bone growth
(20-30) can play a huge role in whether we develop
osteoporosis or not later on.

 It is important to catch osteoporosis early, so that

lifestyle adjustments can be made.
The most common complications of osteoporosis are
fractures.
The International Osteoporosis Foundation estimates
that an osteoporosis related fracture happens every 3
seconds.
Most common fractures are that of the wrist, hip and
spine.
Lifestyle adjustments like not using tobacco or alcohol,
getting enough exercise, eating healthy and taking
vitamins/supplements can be important in treating
osteoporosis.

 Important questions regarding condition and why

the information is important when treating patient.
1. What medications is the patient taking? Specifically, are
they taking bisphosphonates? If so, are they taking it orally
or intravenously?
- The use of bisphosphonates can put the patient at a risk of
developing osteonecrosis of the jaw, or ONJ. Taking
bisphosphonates intravenously is most likely to cause ONJ. This
is most likely to be a factor with procedures that are dealing with
the jaw, such as implants or extractions.

2. Ask the patient about lifestyle risk factors, like smoking,

drinking alcohol and nutritional deficiencies.
- Osteoporosis and periodontal disease have many mutual risk
factors. If patients have these risk factors than they are at a
super high risk of dental problems. It is important to educate the
patient about these factors. Suggest nutritional counseling,
smoking cessation, and lowering alcohol consumption.
3. Ask the patient if they have had any bone density testing
done.
- Patients with reduced bone density because of osteoporosis
are also at risk for oral bone loss. If you have access to bone
density test results you can determine whether the patient is at
a higher risk for oral bone loss. If the patient has not had this
testing, you may want to refer the patient to a physician to have
testing done.

MODIFICATIONS TO CARE FOR DENTAL TREATMENT

When treating a patient with osteoporosis make

sure to take your time to ensure the patient does
not have a fall.
Take extra care when positioning the patient to
ensure they have adequate cushioning and are
stable and comfortable.
Educate osteoporosis patient about oral hygiene
and maintaining good oral health overall.

MODIFICATIONS TO CARE FOR DENTAL TREATMENT (cont.)

Use panoramic x-rays (which you may use anyway) as a tool to

look for any changes in the bone that may indicate the patient is
in a high risk category.
These x-rays
show the
difference
between a
patient with
osteoporosis
(left) and a
patient without
osteoporosis
(right).

 Its important to explain any risk factors the patient may have.
Because osteoporosis risk factors can often be periodontal risk
factors too, this is especially important.
Prevention is especially important with osteoporosis patients.
Because of their lower bone density they are more likely to have
dental problems.
Educate the patient about how they can improve their bone
health, which will in turn improve their oral health. Things like
diet and nutrition, exercise, tobacco and alcohol use.
Help the patient understand what specific changes they can
make in oral hygiene and overall lifestyle that will lower their risk
and improve oral health.

 Oral conditions most common with osteoporosis

patients are periodontal disease, oral bone loss and
loss of teeth.
Osteoporosis patients that are taking bisphosphonates
are at risk of developing osteonecrosis of the jaw, or
ONJ. These patients should try to avoid needing any
procedures dealing with the jaw. If they need these type
of procedures (like extractions or implants) they need to
discuss the risks with the dentist.

 Risk factors include age, gender, family history, use of tobacco,

alcohol consumption, nutritional deficiencies and lack of exercise.
Immediate care plan is to achieve and maintain good oral health
overall. Start with a thorough medical history, take panoramic x-rays
to assess dental and bone situations, do an intra/extra oral exam,
and assess the patients oral needs.
Encourage the patient to make any changes they can in lifestyle and
oral hygiene that may improve their oral health.
Long-term plan should be to maintain good oral health and avoid any
procedures that deal with the jaw. Because osteoporosis patients
have a high risk of periodontal disease and oral bone loss,
prevention and maintaining of oral health is most important.

 Bisphosphonates (antiresorptive medications) like

Fosomax or Boniva (taken orally) or Boniva IV or
Prolia (taken intravenously).
Calcitonin (inhibits bone resorption) like Fortical
or Miacalcin.
Selective Estrogen Receptor Modulators, or
SERMs (inhibit bone resorption) like Evista.

 Patients with
osteoporosis are at a
high risk of having a
bone fracture.
Fractures often are
the result of a fall or
accident.
Most common
osteoporosis related
fractures are that of
the spine, wrist or hip.

 The best way to prevent an osteoporosis related fracture is to avoid

any fall or accident.
Take extra time with the patient, avoiding any obstructions that may
be in their way. Give the patient extra cushioning and make sure
they are comfortable and stable.
In the case that a patient does have a fall resulting in an injury,
immediately stop treatment and get help. Call 911, make sure the
patients vitals are stable, and clear the area.
If the patient can sit or stand, you may want to have them wait in a
wheelchair or other safe sitting position. If the patient cannot stand,
you can keep them comfortable until EMTs arrive. You can give
them a pillow and/or blanket.

1. What condition can be caused by taking Bisphosphonates,

a common medication for osteoporosis patients?
a. osteoarthritis
b. osteopenia
c. osteonecrosis of the jaw
d. necrotizing ulcerative gingivitis

2. List 3 lifestyle risk factors for osteoporosis.

3. What type of dental x-rays would most likely be used to
look for warning signs of osteoporosis?

1. Answer found on slides 5 & 10. (c. osteonecrosis of the jaw)

Bisphosphonates can cause osteonecrosis of the jaw, or ONJ.
2. Answer found on slides 3, 4, 6 & 11.
(smoking, drinking alcohol, nutritional deficiencies)
Smoking cigarettes (or using any tobacco), drinking alcohol, and
having nutritional deficiencies are all lifestyle risk factors that
can contribute to osteoporosis.
3. Answer found on slide 8. (panoramic dental x-rays)
Panoramic dental x-rays are the best dental x-rays to use when
looking for warning signs or changes that may indicate
osteoporosis.

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Wilkins, E. M. (2009). Clinical Practice Of The Dental Hygienist (10th ed., pp. 822-823).
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Vernetti, D. C. (2007, November 1). Osteoporosis; Prevention, Management, and Screening Using
Dental Radiographs. In Dental Care,Com. Retrieved from http://www.dentalcare.com/enUS/dental-education/continuing-education/ce303/ce303.aspx?ModuleName=overview&PartID=1&SectionID=-