Clinical study
Calcium and vitamin D supplements reduce tooth loss in the elderly

https://doi.org/10.1016/S0002-9343(01)00899-3Get rights and content

Abstract

Purpose

Oral bone and tooth loss are correlated with bone loss at nonoral sites. Calcium and vitamin D supplementation slow the rate of bone loss from various skeletal sites, but it is not known if intake of these nutrients affects oral bone and, in turn, tooth retention.

Subjects and methods

Tooth loss was examined in 145 healthy subjects aged 65 years and older who completed a 3-year, randomized, placebo-controlled trial of the effect of calcium and vitamin D supplementation on bone loss from the hip, as well as a 2-year follow-up study after discontinuation of study supplements. Teeth were counted at 18 months and 5 years. A comprehensive oral examination at 5 years included assessment of caries, oral hygiene, and periodontal disease. The odds ratio (OR) and 95% confidence interval (CI) of tooth loss were estimated by stepwise multivariate logistic regression. Initial age (mean ± SD) of subjects was 71 ± 5 years, and the number of teeth remaining was 22 ± 7.

Results

During the randomized trial, 11 of the 82 subjects (13%) taking supplements and 17 of the 63 subjects (27%) taking placebo lost one or more teeth (OR = 0.4; 95% CI: 0.2 to 0.9). During the 2-year follow-up period, 31 of the 77 subjects (40%) with total calcium intake of at least 1000 mg per day lost one or more teeth compared with 40 of the 68 subjects (59%) who consumed less (OR = 0.5; 95% CI: 0.2 to 0.9).

Conclusion

These findings suggest that intake levels of calcium and vitamin D aimed at preventing osteoporosis have a beneficial effect on tooth retention.

Section snippets

Subjects and methods

Information on tooth loss and oral health status was obtained from 145 subjects who completed a 3-year, double-blind, randomized, placebo-controlled trial of the effect of calcium and vitamin D supplementation on bone loss from the hip (11), as well as a 2-year follow-up study during which study supplements were discontinued (21). Collection of dental information was added to the protocol after the randomized trial began (see Figure for the time line of dental data collection in reference to

Randomized controlled trial

The 62 men and 83 women were a mean (± SD) of 71 ± 5 years of age and had 22 ± 7 teeth remaining at the 6-month examination (Table 1).

During the randomized trial, 17 of the 63 subjects (27%) in the placebo group and 11 of the 82 subjects (13%) in the supplemented group lost one or more teeth. Results of the stepwise logistic regression analysis indicated that only supplement status was significantly associated with the odds of tooth loss during the randomized trial (OR = 0.4; 95% CI: 0.2 to

Discussion

Our results support a relation between calcium and vitamin D intake and the risk of tooth loss. During the randomized trial and follow-up period, average calcium and vitamin D levels in the higher intake groups approximated the dietary reference intake values for adults in the United States, which are 1000 to 1200 mg of calcium and 400 to 600 IU of vitamin D (24). Confirmation of our results would suggest that maintenance of the recommended calcium and vitamin D intakes will have a beneficial

References (26)

  • B Dawson-Hughes et al.

    Effect of withdrawal of calcium and vitamin D supplements on bone mass in elderly men and women

    Am J Clin Nutr

    (2000)
  • D.C Tong et al.

    Antibiotic prophylaxis in dentistrya review and practice recommendations

    J Am Dent Assoc

    (2000)
  • A.R Mohammad et al.

    Spinal bone density and tooth loss in a cohort of postmenopausal women

    Int J Prosthodont

    (1997)
  • H May et al.

    Self-reported tooth loss and bone mineral density in older men and women

    Age Ageing

    (1995)
  • E.A Krall et al.

    Tooth loss and skeletal bone density in healthy postmenopausal women

    Osteoporos Int

    (1994)
  • H.W Daniell

    Postmenopausal tooth loss. Contributions to edentulism by osteoporosis and cigarette smoking

    Arch Intern Med

    (1983)
  • R.J Weyant et al.

    The association between osteopenia and periodontal attachment loss in older women

    J Periodontol

    (1999)
  • S.A Earnshaw et al.

    Tooth counts do not predict bone mineral density in early postmenopausal Caucasian women. EPIC study group

    Int J Epidemiol

    (1998)
  • P.J Elders et al.

    The relation between periodontitis and systemic bone mass in women between 46 and 55 years of age

    J Clin Periodontol

    (1992)
  • N von Wowern

    Bone mineral content of mandibles: normal reference values—rate of age-related bone loss

    Calcif Tissue Int

    (1988)
  • J.B Payne et al.

    Longitudinal alveolar bone loss in postmenopausal osteoporotic/osteopenic women

    Osteoporos Int

    (1999)
  • E.A Krall et al.

    Increased risk of tooth loss is related to bone loss at the whole body, hip and spine

    Calcif Tissue Int

    (1996)
  • B Dawson-Hughes et al.

    Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older

    N Engl J Med

    (1997)
  • Cited by (211)

    • The impact of micronutrients on the sense of taste

      2024, Human Nutrition and Metabolism
    • Vitamin D in dentoalveolar and oral health

      2023, Feldman and Pike's Vitamin D: Volume One: Biochemistry, Physiology and Diagnostics
    • The evaluation of the effect of hypercalcemia in oral pathologies

      2021, Journal of Stomatology, Oral and Maxillofacial Surgery
    View all citing articles on Scopus

    Supported by Grant AG10353 from the National Institutes of Health and by an agreement (58-1950-001) with the U.S. Department of Agriculture. Dr. Garcia is supported by Grant K24 DE00419 from the National Institute of Dental and Craniofacial Research. He was a Career Development Awardee from the Health Services Research and Development Service, US Department of Veterans Affairs.

    View full text