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Calcium and vitamin D reduces tooth loss in the elderly
EVIDENCE -BASED CLINICAL PR AC TICE
Calcium and vitamin D reduces tooth loss in the elderly Abstracted from: Krall EA, Wehler C, Garcia RI, Harris SS, Dawson-Hughes B. Calcium and vitamin D supplements reduce tooth loss in the elderly. Am J Med 2001; 111: 452^ 456.
BACKGROUND Low bone mineral density is associated with tooth loss. Calcium and vitamin D supplements slow the rate of skeletal decline, but the e¡ect on tooth loss is unknown. OBJECTIVE To assess the e¡ect of calcium and vitamin D supplements on tooth loss in the elderly. SETTING Location and timeframe not speci¢ed. METHOD Subgroup analysis from a randomised controlled trial. PARTICIPANTS One hundred and forty-¢ve adults aged over 65 participating in a trial of calcium and vitamin D for bone loss from the hip; with bone mineral density of the femoral neck not lower than 2 standard deviations below an age- and sex-matched reference value. People taking bisphosphonates, calcitonin, oestrogen, testosterone, tamoxifen, calcium or vitamin D supplements were excluded. INTERVENTION 500 mg of calcium citrate malate and 700 IU of cholecalciferol per day, or same number of
1462-9410/02/$ - see front matter & 2002 Elsevier Science Ltd. All rights reserved doi:10.1054/ebhc.2002.0496, available online at http://www.idealibrary.com.on
placebo pills containing microcrystalline cellulose for 18 months. OUTCOMES Number of teeth lost, measured by questionnaire 18 months after collection of baseline dental data. MAIN RESULTS Twenty-seven percent of the placebo group lost one or more teeth compared with 13% of those taking supplements (odds ratio 0.4; 95% CI 0.2 to 0.9%). AUTHORS’ CONCLUSIONS Calcium and vitamin D supplements for the prevention of osteoporosis also increase tooth retention. NOTES The trial was originally set up to assess the e¡ect of calcium and vitamin D on bone loss from the hip. The e¡ect on tooth loss was added to the protocol and baseline dental data collected after the trial had been running for 18 months. Dental assessments were only available from a non-random subset of participants who completed the trial. Assessment of the number of teeth lost was dependent on self-report. A comprehensive dental exam was not done at the end of the trial.
Evidence-based Healthcare (2002) 6, 87^ 88
87
Commentary
Literature cited
Loss of bone mineral density is widespread in the elderly.The recent National Osteoporosis Risk Assessment study in the United States showed that almost one-half of women screened in ambulatory practices had low bone mineral density.1 It is now recognized that the oral cavity is also affected by osteoporosis.2 Calcium and vitamin D supplements have been found to be effective in increasing bone mineral density and lowering fracture rates in late postmenopausal women.3 Adequate calcium and vitamin D intake are important adjunctive therapies for osteopenia and osteoporosis.4 This paper evaluates the effect of calcium and vitamin D supplements on tooth loss in the elderly. Although tooth loss was not an a priori study outcome and a periodontal examination was performed on a non-random subset of participants the study provides information about the importance of adequate calcium and vitamin D in reducing tooth loss.The impact of such supplementation is important, since poor oral health predicts weight loss in community dwelling older adults5 and oral health disability has been linked to poor nutritional status.6 Providing advice about calcium and vitamin D supplementation is an important consideration when counseling elderly adults.
1. Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM. Identif|cation and facture outcomes of undiagnosed low bone mineral density in post menopausal women. Results from the National Osteoporosis risk assessment. J Am Med Assoc 2002; 286: 2815^2822. 2. Je¡coat MK.Osteoporosis: a possible modifying factor in oral bone loss. Ann Periodontol 1998; 3: 312^321. 3. Dawson-Hughes B, Dallal GE, Krall EA, Sadowski L, Sahyoun N, Tannenbaum S. A controlled trial of the e¡ect of calcium supplementation on bone density in postmenopausal women. N Engl J Med1990: 323: 878 ^ 883. 4. Morgan SL.Calcium and vitamin D in osteoporosis.Rheumatic Dis Clin North Am 2001; 27: 101^130. 5. Ritchie CS, Joshipura K, Silliman RA, Miller B, Douglas CW. Oral Health problems and signif|cant weight loss among community dwelling older adults. J Gerontol Ser A Biol Sci Med Sci 2000; 55: M366 -71/. 6. Ritchie CS, Burgio KL, Locher JL, Cornwell A, Thomas D, Hardin M, Redden D. Nutritional status of urban homebound older adults. Am J Clin Nutr 1997; 66: 815^ 818.
Sarah L. Morgan, MD, RD, FADA, FACP The University of Alabama at Birmingham USA
88
Evidence-based Healthcare (2002) 6, 87^ 88
& 2002 Elsevier Science Ltd. All rights reserved
Calcium and vitamin D reduces tooth loss in the elderly Abstracted from: Krall EA, Wehler C, Garcia RI, Harris SS, Dawson-Hughes B. Calcium and vitamin D supplements reduce tooth loss in the elderly. Am J Med 2001; 111: 452^ 456.
BACKGROUND Low bone mineral density is associated with tooth loss. Calcium and vitamin D supplements slow the rate of skeletal decline, but the e¡ect on tooth loss is unknown. OBJECTIVE To assess the e¡ect of calcium and vitamin D supplements on tooth loss in the elderly. SETTING Location and timeframe not speci¢ed. METHOD Subgroup analysis from a randomised controlled trial. PARTICIPANTS One hundred and forty-¢ve adults aged over 65 participating in a trial of calcium and vitamin D for bone loss from the hip; with bone mineral density of the femoral neck not lower than 2 standard deviations below an age- and sex-matched reference value. People taking bisphosphonates, calcitonin, oestrogen, testosterone, tamoxifen, calcium or vitamin D supplements were excluded. INTERVENTION 500 mg of calcium citrate malate and 700 IU of cholecalciferol per day, or same number of
1462-9410/02/$ - see front matter & 2002 Elsevier Science Ltd. All rights reserved doi:10.1054/ebhc.2002.0496, available online at http://www.idealibrary.com.on
placebo pills containing microcrystalline cellulose for 18 months. OUTCOMES Number of teeth lost, measured by questionnaire 18 months after collection of baseline dental data. MAIN RESULTS Twenty-seven percent of the placebo group lost one or more teeth compared with 13% of those taking supplements (odds ratio 0.4; 95% CI 0.2 to 0.9%). AUTHORS’ CONCLUSIONS Calcium and vitamin D supplements for the prevention of osteoporosis also increase tooth retention. NOTES The trial was originally set up to assess the e¡ect of calcium and vitamin D on bone loss from the hip. The e¡ect on tooth loss was added to the protocol and baseline dental data collected after the trial had been running for 18 months. Dental assessments were only available from a non-random subset of participants who completed the trial. Assessment of the number of teeth lost was dependent on self-report. A comprehensive dental exam was not done at the end of the trial.
Evidence-based Healthcare (2002) 6, 87^ 88
87
Commentary
Literature cited
Loss of bone mineral density is widespread in the elderly.The recent National Osteoporosis Risk Assessment study in the United States showed that almost one-half of women screened in ambulatory practices had low bone mineral density.1 It is now recognized that the oral cavity is also affected by osteoporosis.2 Calcium and vitamin D supplements have been found to be effective in increasing bone mineral density and lowering fracture rates in late postmenopausal women.3 Adequate calcium and vitamin D intake are important adjunctive therapies for osteopenia and osteoporosis.4 This paper evaluates the effect of calcium and vitamin D supplements on tooth loss in the elderly. Although tooth loss was not an a priori study outcome and a periodontal examination was performed on a non-random subset of participants the study provides information about the importance of adequate calcium and vitamin D in reducing tooth loss.The impact of such supplementation is important, since poor oral health predicts weight loss in community dwelling older adults5 and oral health disability has been linked to poor nutritional status.6 Providing advice about calcium and vitamin D supplementation is an important consideration when counseling elderly adults.
1. Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM. Identif|cation and facture outcomes of undiagnosed low bone mineral density in post menopausal women. Results from the National Osteoporosis risk assessment. J Am Med Assoc 2002; 286: 2815^2822. 2. Je¡coat MK.Osteoporosis: a possible modifying factor in oral bone loss. Ann Periodontol 1998; 3: 312^321. 3. Dawson-Hughes B, Dallal GE, Krall EA, Sadowski L, Sahyoun N, Tannenbaum S. A controlled trial of the e¡ect of calcium supplementation on bone density in postmenopausal women. N Engl J Med1990: 323: 878 ^ 883. 4. Morgan SL.Calcium and vitamin D in osteoporosis.Rheumatic Dis Clin North Am 2001; 27: 101^130. 5. Ritchie CS, Joshipura K, Silliman RA, Miller B, Douglas CW. Oral Health problems and signif|cant weight loss among community dwelling older adults. J Gerontol Ser A Biol Sci Med Sci 2000; 55: M366 -71/. 6. Ritchie CS, Burgio KL, Locher JL, Cornwell A, Thomas D, Hardin M, Redden D. Nutritional status of urban homebound older adults. Am J Clin Nutr 1997; 66: 815^ 818.
Sarah L. Morgan, MD, RD, FADA, FACP The University of Alabama at Birmingham USA
88
Evidence-based Healthcare (2002) 6, 87^ 88
& 2002 Elsevier Science Ltd. All rights reserved