An overview of osteoporosis for the practising prosthodontist

doi:10.1111/j.1741‐2358.2009.00324.x
An overview of osteoporosis for the practising prosthodontist Osteoporosis is an insidious and common bone disorder of the modern age, as a result of the rapidly increasing number of older people in the total population. It has long been concluded that this disease has definite deleterious effects on the stomatognathic system and is therefore of major concern to a Prosthodontist. If features on a dental radiograph, which are the most commonly required radiographs, can be detected regularly and consistently, it would place a prosthodontist in a position to refer the patient for timely management and also modify his treatment plan, greatly improving the prognosis. Available literature was therefore reviewed for pathophysiology, dental radiographic screening measures, implications and management of osteoporosis from the perspective of a prosthodontist.     

Clinical problems related to postmenopausal osteoporosis]

Authors discuss current hypotheses related to the causes of osteoporosis and its possible therapy. One of the frequent menopausal disorders is osteoporosis, i.e. decrease in bone density, which may eventually lead to the pathological fractures and marked deformities of the skeleton. Etiology of the postmenopausal osteoporosis is not clearly explained. However, one may assume that hormonal disturbances, especially estrogen deficit, plays an important causative role. The treatment is difficult. It is usually aimed at preventing of bone loss.     

Treatment of spinal osteoporosis in postmenopausal women.

Ninety-five postmenopausal women with unequivocably wedged or compressed vertebrae in whom the recognised causes of secondary osteoporosis had been excluded were studied, 41 having no treatment and the rest one or more of six different treatments. The treatment regimens comprised calcium supplements, vitamin D, calcium and vitamin D, ethinyloestradiol or--where oestrogens were contraindicated--norethisterone, 1 alpha-hydroxycholecalciferol (1 alpha-OHD3), or hormones with 1 alpha-OHD3. The seven groups were reasonably comparable in most respects except that the hormone-treated patients were younger and had a higher initial cortical area ratio than the others, and the calcium- and hormone-treated groups had the best initial radio-calcium absorption. The untreated osteoporotic patients lost cortical bone more rapidly than do normal postmenopausal women. Three treatments (calcium, hormones, and 1 alpha OHD3 plus hormones) appear to be useful in modifying the disease, and two treatments (vitamin D and 1 alpha-OHD3) useless or even harmful. Vitamin D and 1 alpha-OHD3 are more safely used in conjunction with oestrogens, which protect bone against resorption, than on their own.     

PEMFs治疗绝经后骨质疏松症大鼠的安全性影响

目的:探讨低频率低强度脉冲电磁场(PEMFs)治疗绝经后骨质疏松症(OP)大鼠安全性的影响.方法:3-5月龄雌性SD大鼠经手术分别摘取两侧卵巢(OVX),对照组实行假性去除卵巢手术(Sham),术后1月对手术组大鼠分组治疗,3个月后处死动物,对经过PEMFs照射治疗的大鼠进行全面观察,通过监测机体一般生命症状、重要脏器指数、血液生化学指标进行安全性评价.结果:通过一般体征、摄食量观察,血液生化指标检测、动物脏器解剖,经过统计学分析,发现经过为期3个月的治疗后,对大鼠的肝脏、肾脏功能没有明显影响,重要脏器指数与正常组没有差异,提示PEMFs照射对骨质疏松大鼠没有影响.结论:PEMFs照射治疗对于骨质疏松大鼠是安全的.     

Urinary excretion of glycosaminoglycans in patients with postmenopausal osteoporosis.

The organic bone matrix contains glycosaminoglycans (GAG) of which the precise function and importance in bone mineralisation are still unclear. We examined 85 persons--35 healthy women (25 premenopausal [preMP] mean aged 40.7 years; 10 menopausal [MP] mean aged 59.3 years) and 50 patients with postmenopausal osteoporosis [PMOP] at a mean age 60.4 years. The dynamic of urinary excretion of GAG was measured in 24-hour collected urine by precipitation with cetylpyridinum chloride and spectrophotometry at 560 nm, corrected for the level of excretion of creatinine. There was a significant increase in GAG excretion in patients with PMOP compared with healthy persons (8.25 mg/g and 9.53 mg/g vs 24.11 mg/g; p < 0.0001). A significant positive correlation was established between GAG and calcium urinary excretion and a negative one between GAG and serum estradiol levels. During the treatment with calcitonin the excretion of GAG was decreased which can be used for monitoring the changes of bone metabolism.     

MicroRNA通过肠道菌群对绝经后骨质疏松症影响的机制探讨

胃肠道是营养和矿物质高效吸收的重要部位。研究显示胃肠道微生物群通过肠-骨轴对骨质量具有调节作用,其作用机制十分复杂,主要通过矿物质吸收、激素控制和免疫调节来实现。中药可以调节肠道菌群,起到治疗绝经后骨质疏松症的作用。近期研究发现,microRNA通过调节肠道微生物基因,改变肠道微生物的生理功能,从而调节骨代谢,影响绝经后骨质疏松症的发生与发展。本文就microRNA调节肠道菌群的研究现状作一综述,探讨绝经后骨质疏松症的调节机制,为绝经后骨质疏松症的肠道微生态研究提供一定的理论依据。     

The effect of osteoporosis on self-report sleep quality in postmenopausal women

We aimed to show the effect of osteoporosis on sleep quality in 59 postmenopausal women. The participants’ bone-mineral density levels were measured by dual-energy X-ray absorptiometry (DEXA). According to their DEXA results, participants were divided into two groups as osteoporotics and controls. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality. Fourteen osteoporotic women (43.8%) and four controls (14.8%) were “poor” sleepers (p < 0.05). Postmeno-pausal women with osteoporosis scored greater on the “sleep latency” and “sleep duration” components of PSQI than controls. According to the findings of our study, osteoporosis is a risk factor for poor sleep quality in postmenopausal women.

     

Blueberry prevents bone loss in ovariectomized rat model of postmenopausal osteoporosis

The objective of the present study was to explore the bone protective role of blueberry in an ovariectomized rat model. Thirty 6-month-old female Sprague-Dawley rats were either sham-operated (Sham) or ovariectomized (Ovx) and divided into three groups: Sham, Ovx (control), Ovx+blueberry (5% blueberry w/w). After 100 days of treatment, rats were euthanized, and blood and tissues were collected. Bone mineral density (BMD) and content of whole body, right tibia, right femur and fourth lumbar vertebra were assessed via dual-energy X-ray absorptiometry. As expected, Ovx resulted in loss of whole-body, tibial, femoral, and 4th lumbar BMD by approximately 6%. Blueberry treatment was able to prevent the loss of whole-body BMD and had an intermediary effect on prevention of tibial and femoral BMD when compared to either Sham or Ovx controls. The bone-protective effects of blueberry may be due to suppression of Ovx-induced increase in bone turnover, as evident by lowered femoral mRNA levels of alkaline phosphatase, collagen type I and tartrate-resistant acid phosphatase to the Sham levels. Similarly, serum osteocalcein levels were also lower in the blueberry group when compared to the Ovx control group, albeit not significantly. In summary, our findings indicate that blueberry can prevent bone loss as seen by the increases in BMD and favorable changes in biomarkers of bone metabolism.