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Bones Versus Teeth

Introduction: A 200% increase in population growth among those over 85 is projected in the United States by 2050. Approximately half of women over 50 will experience an osteoporotic fracture in their lifetime. Osteoporosis disproportionately affects old-old adults (those between 85 and 95) as more t...

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Autores principales: Mammadova, Aytan Siraj, Hodge, MaKenzie, Folawewo, Kehinde Matilda, Cobbs, Elizabeth, Nunlee-Bland, Gail Louise, Odonkor, Wolali Akua-Sabia, Ganta, Vijaya A, Zenebe, Anteneh Woldetensay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089331/
http://dx.doi.org/10.1210/jendso/bvab048.375
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author Mammadova, Aytan Siraj
Hodge, MaKenzie
Folawewo, Kehinde Matilda
Cobbs, Elizabeth
Nunlee-Bland, Gail Louise
Odonkor, Wolali Akua-Sabia
Ganta, Vijaya A
Zenebe, Anteneh Woldetensay
author_facet Mammadova, Aytan Siraj
Hodge, MaKenzie
Folawewo, Kehinde Matilda
Cobbs, Elizabeth
Nunlee-Bland, Gail Louise
Odonkor, Wolali Akua-Sabia
Ganta, Vijaya A
Zenebe, Anteneh Woldetensay
author_sort Mammadova, Aytan Siraj
collection PubMed
description Introduction: A 200% increase in population growth among those over 85 is projected in the United States by 2050. Approximately half of women over 50 will experience an osteoporotic fracture in their lifetime. Osteoporosis disproportionately affects old-old adults (those between 85 and 95) as more than half of those admitted to the hospital for hip fracture are over 80 years of age. Older adults are also likely to need dental care. The American Dental Association guidelines offer preventive recommendations for those over 60 years of age but do not address the nuances of treatment options for nonagenarian persons. This case illustrates the treatment dilemma of nonagenarians wishing to optimize both bone and dental health. Case: We have a 95-year-old performance artist, who seeks to optimize bone health in the face of recommended dental work. She has been physically active her whole life and consumes adequate quantities of calcium and Vitamin D. She doesn’t smoke but has needed periodic glucocorticoids for exacerbations of chronic lung disease. At age 84 she began ibandronate but stopped due to worsening of esophageal reflux. She was then treated with teriparatide for 2 years. DEXA scans have shown declining hip T scores from -2.8 at age 88 to -3.5 at age 94 (osteoporotic bone density: T-score lower than -2.5). Her dentist recommended the extraction of several teeth before beginning zoledronate. She refused tooth extraction and sought treatment options to enhance her bone density. Discussion: Persons of advanced age are likely to have oral health problems requiring dental treatment. Bone health treatments such as bisphosphonates and denosumab are generally safe but can potentially cause osteonecrosis of the jaw even with simple tooth extraction in old-old population. Specific guidelines are lacking for treatment to maintain bone and dental health. The American Association of Oral and Maxillofacial Surgeons suggests that extractions and implants can be conducted as usual in patients who have been treated with oral bisphosphonates for less than four years and lack other clinical risk factors. A delay of two months is suggested for those who have been treated for more than four years or has taken glucocorticoids concomitantly. The approach is uncertain for old-old adults who are taking treatment but develop a need for dental surgery. More research is needed about options for optimizing dental health while enhancing bone density in aging population.
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spelling pubmed-80893312021-05-06 Bones Versus Teeth Mammadova, Aytan Siraj Hodge, MaKenzie Folawewo, Kehinde Matilda Cobbs, Elizabeth Nunlee-Bland, Gail Louise Odonkor, Wolali Akua-Sabia Ganta, Vijaya A Zenebe, Anteneh Woldetensay J Endocr Soc Bone and Mineral Metabolism Introduction: A 200% increase in population growth among those over 85 is projected in the United States by 2050. Approximately half of women over 50 will experience an osteoporotic fracture in their lifetime. Osteoporosis disproportionately affects old-old adults (those between 85 and 95) as more than half of those admitted to the hospital for hip fracture are over 80 years of age. Older adults are also likely to need dental care. The American Dental Association guidelines offer preventive recommendations for those over 60 years of age but do not address the nuances of treatment options for nonagenarian persons. This case illustrates the treatment dilemma of nonagenarians wishing to optimize both bone and dental health. Case: We have a 95-year-old performance artist, who seeks to optimize bone health in the face of recommended dental work. She has been physically active her whole life and consumes adequate quantities of calcium and Vitamin D. She doesn’t smoke but has needed periodic glucocorticoids for exacerbations of chronic lung disease. At age 84 she began ibandronate but stopped due to worsening of esophageal reflux. She was then treated with teriparatide for 2 years. DEXA scans have shown declining hip T scores from -2.8 at age 88 to -3.5 at age 94 (osteoporotic bone density: T-score lower than -2.5). Her dentist recommended the extraction of several teeth before beginning zoledronate. She refused tooth extraction and sought treatment options to enhance her bone density. Discussion: Persons of advanced age are likely to have oral health problems requiring dental treatment. Bone health treatments such as bisphosphonates and denosumab are generally safe but can potentially cause osteonecrosis of the jaw even with simple tooth extraction in old-old population. Specific guidelines are lacking for treatment to maintain bone and dental health. The American Association of Oral and Maxillofacial Surgeons suggests that extractions and implants can be conducted as usual in patients who have been treated with oral bisphosphonates for less than four years and lack other clinical risk factors. A delay of two months is suggested for those who have been treated for more than four years or has taken glucocorticoids concomitantly. The approach is uncertain for old-old adults who are taking treatment but develop a need for dental surgery. More research is needed about options for optimizing dental health while enhancing bone density in aging population. Oxford University Press 2021-05-03 /pmc/articles/PMC8089331/ http://dx.doi.org/10.1210/jendso/bvab048.375 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Bone and Mineral Metabolism
Mammadova, Aytan Siraj
Hodge, MaKenzie
Folawewo, Kehinde Matilda
Cobbs, Elizabeth
Nunlee-Bland, Gail Louise
Odonkor, Wolali Akua-Sabia
Ganta, Vijaya A
Zenebe, Anteneh Woldetensay
Bones Versus Teeth
title Bones Versus Teeth
title_full Bones Versus Teeth
title_fullStr Bones Versus Teeth
title_full_unstemmed Bones Versus Teeth
title_short Bones Versus Teeth
title_sort bones versus teeth
topic Bone and Mineral Metabolism
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089331/
http://dx.doi.org/10.1210/jendso/bvab048.375
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