Download Document

Unit 21
DISEASE RISK PREVENTION
Osteoporosis & Dental Caries
Objectives
 To describe the process of osteoporosis and how it develops
 To have an understanding of factors that will reduce the risk of
osteoporosis
 To understand the contributing factors that lead to dental caries.
What is Osteoporosis?14
Osteoporosis is a condition in which the bones become fragile and brittle, leading to a
higher risk of fractures (breaks or cracks) than normal bone. Osteoporosis occurs
when bones lose minerals such as calcium, and the body cannot replace these
minerals fast enough to keep the bones healthy. As a result, bones become thinner
and less dense. Osteoporosis is almost as common as high blood pressure, and is
more common than high cholesterol. Any bone can be affected by osteoporosis, but
the most common sites are bones in the hip, spine, wrist, ribs, pelvis and upper arm.
Osteoporosis has no signs or symptoms usually until a fracture occurs - this is why
osteoporosis is often called a silent disease. Fractures due to osteoporosis are
known as osteoporotic fractures. These can lead to changes in posture (eg
developing a stoop or Dowager's hump in your back), muscle weakness, loss of
height and deformity of the area affected. Fractures can lead to long-term pain and
disability, loss of independence, and may even contribute to premature death.14
The cascade effect14
Once one fracture has occurred, the chances of having another fracture are much
higher compared to someone who has not had any fractures. This 'cascade effect'
means that women who have suffered a fracture in their spine are over 4 times more
likely to have another fracture within the next year, compared to women who have
never had an osteoporotic fracture. People who have had three or more fractures are
11 times more likely to have another fracture compared to someone who has not had
one. To prevent this cascade effect, it is essential that osteoporotic fractures are
identified and treated as quickly as possible.14
Why do more women than men get osteoporosis?14
Both men and women are affected by osteoporosis; one in two women and one in
three men over the age of 60 will have a fracture due to osteoporosis. However,
women are at a greater risk of developing this condition because of the hormonal
changes that occur at the time of menopause. estrogen is a hormone that is
important for maintaining healthy bones, and when estrogen levels decrease during
menopause, the bones lose calcium and other minerals at a much faster rate than
they did before. While men also lose bone density as they age, it tends to remain
adequate until much later in life.14
297
Unit 21
DISEASE RISK PREVENTION
Osteoporosis & Dental Caries
Osteoporosis in Australia14
Osteoporosis is a major health problem in Australia, and studies around the country
show that the incidence of fractures due to osteoporosis is increasing as the
population ages. For example:

Every 8 minutes, someone is admitted to an Australian hospital with an
osteoporotic fracture. This is expected to rise to every 3-4 minutes by the year
2021.

In 2002, 1.9 million people in Australia had osteoporosis. This number is
expected to rise to 3 million by the year 2021.
As many as 4 out of 5 people with osteoporosis don't know that they have it although
they are at risk of fracturing a bone. More than 3 out of 4 people with known
osteoporotic fractures are not treated to prevent further bone loss and stop the
fracture cascade.14
HOW DOES OSTEOPOROSIS DEVELOP11?
Osteoporosis is caused by a loss of calcium from the bones. To understand how this
happens, let’s look at the role and delicate balance of calcium in the body11.
Calcium is an important nutrient for bone health through life, 99% of the body’s
calcium is stored in the bones and the teeth. Since bones are constantly wearing
away, we need calcium in the diet to rebuild the bone structure 13.
The other 1% of calcium is found in the body fluids, where it plays a crucial role in the
clotting of blood and the functioning of nerves and muscles8.
The calcium in the body fluids must be kept constant. When the calcium
concentration in the body fluids falls too low and not enough is gained from food, it is
withdrawn out of the bones. A small ‘leaching’ of calcium from the bones can, over
many years, lead to osteoporosis11,12.
REDUCING YOUR RISK11

Eat calcium-containing foods. Good sources are dairy foods, such as milk,
yoghurt and cheese, calcium fortified soy beverages (such as Sanitarium So
Good) and yoghurts. Calcium is also found in tofu, nuts (such as almonds and
brazils), sesame seeds, dried figs, dried apricots and Asian greens (such as
bok choy) 11.

Eat more soy foods. Research suggests that certain factors in soy foods can
promote healthy bones1,6. Soy protein may cause the loss of less calcium
from the body via the urine than animal protein. This leaves more calcium
available to maintain healthy bones6. In addition, isoflavones (natural plant
298
Unit 21
DISEASE RISK PREVENTION
Osteoporosis & Dental Caries
chemicals) found in soy may increase bone formation (particularly in postmenopausal women), which helps to strengthen bones1, 11.

Get the maximum amount of calcium possible from food11. There are a
number of factors that can interfere with calcium absorption. These factors
include:

A high salt intake8

Too much caffeine8

A high protein intake, particularly from animal sources6

Not enough vitamin D, since this vitamin helps to regulate
absorption13

Phosphates, from soft drinks4,5

Get more exercise. Physical activity is a very important part of preventing
osteoporosis. Just as using muscles strengthens them, our bones become
denser and stronger in response to mechanical stress13. Make weightbearing exercise a priority. Try exercises like walking, running, cycling and
activities such as gardening and mowing the grass11.

Avoid alcohol and smoking. Smoking and heavy alcohol intake are risk
factors for developing osteoporosis11,13.

Calcium supplements. Taking a calcium supplement instead of eating a
calcium-rich food can mean missing out on other useful nutrients usually
present in such foods, such as, a range of vitamins and minerals and other
compounds that help to protect against disease11.
New Recommended Daily Intake (RDI) for calcium, April 2006, for Australia 14

Infants and children –

Adolescents –
1300 mg calcium per day

Young women –
1000 mg calcium per day

Women and men -
1000 mg calcium per day

Postmenopausal women –
1300 mg calcium per day.

Pregnant and lactating women - 1300 mg calcium per day

Women who are breast feeding - 1300 mg calcium per day
700 mg calcium per day
WOMEN MORE AT RISK THAN MEN11
Bone mass slowly begins to decrease in both men and women, from the age of about
4013. However, after menopause, women tend to be at greater risk of developing
osteoporosis than men13. This is due to two main reasons.
299
Unit 21
DISEASE RISK PREVENTION
Osteoporosis & Dental Caries
1. Women have lighter bones than men.
2. A drop in estrogen levels (a female hormone) after menopause
quickens the loss of calcium from bones13.
Underweight women and those experiencing menstrual irregularities or absence are
at an even greater risk of developing osteoporosis3, 11.
(See Unit 13 for more information on Calcium)
DENTAL CARIES7
(Holes in your teeth that are not meant to be there!)
Every time we eat or drink, our teeth are under attack from food acids and plaque
acids produced from carbohydrates and sugars by bacteria present in our mouths.
The acid attack lasts for approximately 20 minutes, until food particles are diluted and
washed away by saliva.
The mouth then enters a recovery mode – minuscule quantities of tooth minerals
dissolved during the acid attack phase are replaced and rebuilt – but that only
happens if there is enough time before the next acid challenge commences 5!!
There is a constant balancing between demineralisation and re-mineralisation in a
healthy mouth. Continual acid attack destroys the balancing act and below the
surface of the enamel a honeycomb effect of tiny holes develops. The tooth
becomes fragile and over time the weakened structure caves in. Once a hole has
penetrated the tough enamel of the tooth surface, the way is open for bacteria to
enter and the decay process speeds up dramatically.
Even after a filling has be placed, the tooth will never be as strong and resistant to
future damage as it was when it was structurally sound. However if the filling is not
placed and the initial pain of an irritable tooth is ignored, the bacteria slide down the
tubular structure of the dentine and reach the nerve pulp in the middle of the tooth
and in a short time a dental abscess is formed. The extreme pain suffered can only
be remedied by extraction or an expensive root canal therapy. Premature loss of
teeth has dire consequences related to the drifting and tipping movement of the other
teeth. This results in not only an aesthetic problem – your smile is permanently
damaged by gaps left after the extraction, - but also jaw joint pain, food trapped
between teeth resulting in bad breath, and a continuation of the decay cycle.
Replacing a missing tooth with a ceramic bridge or implant or denture is also an
expensive alternative to early detection and treatment of dental caries.
Young adults have the opportunity of keeping their teeth strong and problem free for
life – dental caries is a self-inflicted disease and also the most preventable! So what
goes wrong! Why are young people suffering from a persisting problem that was
thought to be diminishing. The answers lie in the following lifestyle changes:
 “grazing” instead of regular meals
 eat and run habits
 skipping brushing
 smoking and drug use
300
Unit 21
DISEASE RISK PREVENTION
Osteoporosis & Dental Caries
 stress
 fast food, junk food and convenience foods
 sweet snacks and soft drinks
 becoming too busy to visit the dentist
 budget problems which means that money for a dental examination is not a
priority
 moving out of home with the resultant freedom from disciplines imposed by
school and parents, the freedom to make own decisions and to establish
their own rules
 eating disorders
All these factors result in an imbalance between acid attack and natural recovery.
We can easily get into a habit of eating sweet foods and drinking sugary or acidic
drinks continually, without realising that we are risking major problems with our teeth.
It is important then that meals be at regular times with a good time between eating to
allow the mouth to re-mineralise and that sweet foods be kept to a minimum 7.
pH of Commonly Used Drinks7
(the lower the number, the more acidic in nature)
Drink
Cola drinks:
Sugared
Diet
Sport drinks
Citrus based fruit drink
Raspberry / lime cordial
Apple juice
Rose hip syrup
Orange mango fruit drink
Natural orange juice
pH
2.4
3.2
2.8-3.2
2.8
2.8
3.3
2.9
3.2
3.6
THE ROLE OF SALIVA7
Saliva is nature’s miracle in your mouth. It is the primary defence for the oral
environment and is particularly important for protecting exposed tooth surfaces from
the ravages of acid attack. It works by neutralising acid challenges, flushing food and
bacteria from the oral cavity, acting as a lubricant, forming a pellicle on the tooth
surface, delivering calcium, phosphates and fluoride to the tooth surface. So
anything that disturbs this balance between acid and saliva tips it toward disease of
the mouth. When the pH of the mouth lowers (ie. becomes more acidic) there is a
softening of external tooth surfaces and this leads to increased wear of the biting
surfaces, erosion and abrasion of the flat surfaces. An acidic environment favours a
proliferation of more aciduric and cariogenic bacteria leading to loss of tooth structure
301
Unit 21
DISEASE RISK PREVENTION
Osteoporosis & Dental Caries
from dental caries. Other signs of a more acidic oral environment include infections
with candida albicans, halitosis and tooth sensitivity.
So an important part of this health equation is obviously maintaining healthy saliva
flow. This becomes even more important with ageing. Your saliva is affected by:
1. dehydration – caused by
 an inadequate fluid intake
 caffeine as in cola drinks, coffee and energy drinks
 alcohol
 strenuous physical activity
 swimming
2. stress
3. smoking
4. diabetes
5. saliva gland pathology – head and neck radiation or Sjogren’s syndrome
6. chronic renal failure
7. alcoholism
8. Hepatitis C
9. Abuse of cannabis, heroin and amphetamines
10. Menopausal hormone imbalance
11. Medication side effects.
From this list it is easy to see how the growing and ageing Australian population who
have increased teeth retention need to be also aware of the dangers of causing an
upset to the saliva balance, particularly regarding medication side effects.
The drinking of only water between meals is important for the healthy flow of saliva 7.
SUMMARY
It is not only important what you eat and drink and when but consideration of the
healthy flow of saliva is vital to maintain the oral balance that exists between the
demineralising effect on the tooth surface caused by acids and by saliva with its
buffering and re-mineralising benefits7.
302
Unit 21
DISEASE RISK PREVENTION
Osteoporosis & Dental Caries
REFERENCES:
1. Anderson J, Garner S;
THE EFFECTS OF PHYTO-ESTROGENS ON BONE
Nutrition Research 1997;17:10:1617-1632
2. Australian Bureau of Statistics;
NATIONAL NUTRITION SURVEY: SELECTED HIGHLIGHTS
Australia 1997
3. Australian National Consensus Conference;
THE PREVENTION AND MANAGEMENT OF OSTEOPOROSIS.
CONSENSUS STATEMENT 1996
MJA 1997;167(suppl):S4-S15
4. Butler T, Butler D, Stanton H;
VEGETARIAN COOKING DEMONSTRATOR’S MANUAL –
2nd EDITION
Adventist Health Department &
Sanitarium Nutrition Education Service. 1995: E125-E137
5. Craig W;
NUTRITION AND WELLNESS
Golden Harvest Books Berrien Springs Michigan.
1999: 53-54,169-183
6. Itoh R, Nishiyama N, Suyama Y;
DIETARY PROTEIN AND URINARY EXCRETION OF CALCIUM:
A CROSS-SECTIONAL STUDY IN A HEALTHY JAPANESE
POPULATION
Am J Clin Nutr 1988;67:438-444
7. Martin W, BDSc;
Article – DENTAL CARIES:
HOLES IN YOUR TEETH THAT ARE NOT MEANT TO BE THERE!
Burnie Tasmania 2002
8. New Zealand National Health Committee;
PREVENTION OF OSTEOPOROSIS IN OLDER POPULATIONS:
A REPORT
August 1997
9. NHMRC;
RECOMMENDED DIETARY INTAKES FOR USE IN AUSTRALIA
AGPS Canberra 1991
10. Reid I, Prof.;
Sanitarium Communication
University of Auckland, February 1999
11. Sanitarium Nutrition Education Service;
OSTEOPOROSIS: WHAT CAN YOU DO TO PREVENT IT?
Sanitarium Health Food Company March 1999
303
Unit 21
DISEASE RISK PREVENTION
Osteoporosis & Dental Caries
12. Stanton R;
COMPLETE BOOK OF FOOD AND NUTRITION
Simon & Schuster, Australia 1995
13. Wahlqvist M. L; FOOD AND NUTRITION – Australasia, Asia and the Pacific
Allen & Unwin Pty Ltd Crows Nest NSW 1997:
14. Osteoporosis Australia; osteoporosis.org.au 2006
304