Relationship of Number of Missing Teeth to Hip Fracture in Elderly Patients: A Cohort Pilot Study Jennifer Priebe, DDS MS,1 Robert A. Wermers, MD,2 Stephen A. Sems, MD,3 Christopher M. Viozzi, DDS,4 & Sreenivas Koka, DDS MS PhD MBA1,5,6,7 1
Formerly, Division of Prosthodontics, Mayo Clinic, Rochester, MN Division of Endocrinology, Mayo Clinic, Rochester, MN 3 Division of Orthopedic Surgery, Mayo Clinic, Rochester, MN 4 Division of Oral and Maxillofacial Surgery, Mayo Clinic, Rochester, MN 5 Advanced Prosthodontics, Loma Linda University School of Dentistry, Loma Linda, CA 6 Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 7 Koka Dental Clinic, San Diego, CA 2
Keywords Count; fracture; hip; mortality; tooth. Correspondence Sreenivas Koka, Koka Dental Clinic, 8031 Linda Vista Rd., Ste 210, San Diego, CA 92111. E-mail: [email protected] None of the authors have any conflicts of interest. Accepted February 3, 2017 doi: 10.1111/jopr.12626
Abstract Purpose: To determine the relationship between the number of missing natural teeth or remaining natural teeth and osteoporotic hip fracture in elderly patients and to determine the relationship between the number of missing teeth or remaining teeth and osteoporotic fracture risk assessment (FRAX) probability. Materials and Methods: Number of missing teeth was determined by clinical oral exam on a total of 100 subjects, 50 with hip fractures and 50 without. Ten-year fracture risk and hip fracture risk probabilities were calculated using the FRAX tool. Statistical analyses were performed to determine strength of associations between number of missing natural teeth and likelihood of experiencing a fracture. Degree of correlation between number of missing natural teeth and FRAX probabilities were calculated. Results: There appears to be an association between the number of missing natural teeth and hip fractures. For every 5-tooth increase in the number of missing teeth, the likelihood of being a subject in the hip fracture group increased by 26%. Number of missing natural teeth was positively correlated with FRAX overall fracture and hip fracture probability. Conclusions: Number of missing natural teeth may be a valuable tool to assist members of medical and dental teams in identifying patients with higher FRAX scores and higher likelihood of experiencing a hip fracture. Additional research is necessary to validate these findings.
The etiology of osteoporosis has been identified to include a variety of factors including increasing age, female gender, glucocorticoid use, alcohol use, history of previous fracture, history of maternal fracture, low bone mineral density,1-4 and frailty.5,6 Furthermore, evidence indicates that keeping teeth and replacing missing teeth with dentures is associated with fewer falls7,8 and frailty.9,10 The 1-year mortality rate following hip fracture has been reported to be 25%, with ranges from 9% to 36%.11,12 Several factors have been found to be associated with increased mortality following osteoporotic hip fracture, including increasing age, male sex, delayed time from fracture to surgery, smoking, and history of hemodialysis.13-15 In the absence of screening measures such as bone mineral density (BMD) values to help determine fracture risk and identify osteoporosis, other surrogate markers are used to iden-
tify those at risk of skeletal fragility fractures. To this end, Green et al identified five physical examination outcomes that were positively associated with the likelihood of a patient being osteoporotic.16 Four of the five factors aligned well with a preponderance of preceding scientific literature, which indicated that low body weight (
Formerly, Division of Prosthodontics, Mayo Clinic, Rochester, MN Division of Endocrinology, Mayo Clinic, Rochester, MN 3 Division of Orthopedic Surgery, Mayo Clinic, Rochester, MN 4 Division of Oral and Maxillofacial Surgery, Mayo Clinic, Rochester, MN 5 Advanced Prosthodontics, Loma Linda University School of Dentistry, Loma Linda, CA 6 Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, CA 7 Koka Dental Clinic, San Diego, CA 2
Keywords Count; fracture; hip; mortality; tooth. Correspondence Sreenivas Koka, Koka Dental Clinic, 8031 Linda Vista Rd., Ste 210, San Diego, CA 92111. E-mail: [email protected] None of the authors have any conflicts of interest. Accepted February 3, 2017 doi: 10.1111/jopr.12626
Abstract Purpose: To determine the relationship between the number of missing natural teeth or remaining natural teeth and osteoporotic hip fracture in elderly patients and to determine the relationship between the number of missing teeth or remaining teeth and osteoporotic fracture risk assessment (FRAX) probability. Materials and Methods: Number of missing teeth was determined by clinical oral exam on a total of 100 subjects, 50 with hip fractures and 50 without. Ten-year fracture risk and hip fracture risk probabilities were calculated using the FRAX tool. Statistical analyses were performed to determine strength of associations between number of missing natural teeth and likelihood of experiencing a fracture. Degree of correlation between number of missing natural teeth and FRAX probabilities were calculated. Results: There appears to be an association between the number of missing natural teeth and hip fractures. For every 5-tooth increase in the number of missing teeth, the likelihood of being a subject in the hip fracture group increased by 26%. Number of missing natural teeth was positively correlated with FRAX overall fracture and hip fracture probability. Conclusions: Number of missing natural teeth may be a valuable tool to assist members of medical and dental teams in identifying patients with higher FRAX scores and higher likelihood of experiencing a hip fracture. Additional research is necessary to validate these findings.
The etiology of osteoporosis has been identified to include a variety of factors including increasing age, female gender, glucocorticoid use, alcohol use, history of previous fracture, history of maternal fracture, low bone mineral density,1-4 and frailty.5,6 Furthermore, evidence indicates that keeping teeth and replacing missing teeth with dentures is associated with fewer falls7,8 and frailty.9,10 The 1-year mortality rate following hip fracture has been reported to be 25%, with ranges from 9% to 36%.11,12 Several factors have been found to be associated with increased mortality following osteoporotic hip fracture, including increasing age, male sex, delayed time from fracture to surgery, smoking, and history of hemodialysis.13-15 In the absence of screening measures such as bone mineral density (BMD) values to help determine fracture risk and identify osteoporosis, other surrogate markers are used to iden-
tify those at risk of skeletal fragility fractures. To this end, Green et al identified five physical examination outcomes that were positively associated with the likelihood of a patient being osteoporotic.16 Four of the five factors aligned well with a preponderance of preceding scientific literature, which indicated that low body weight (
