More news you can use

Topics covered by Maria Perno Goldie, RDH, MS, in this installment of news that you can use include broken bone healing for smokers, bone loss and menopause, treatment for osteoporosis, and a new position statement for the Academy of Nutrition and Dietetics regarding oral health and nutrition.

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Smokers with broken bones heal less quickly
A regular smoker with a broken leg bone can expect to use crutches a month longer than a nonsmoker with the same injury, according to a recent study.(1) It takes 30 weeks for a regular smoker to heal a fracture, six weeks longer than a nonsmoker.

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The study, presented in March at the American Academy of Orthopaedic Surgeons annual meeting, examined more than 6,400 people across three medical study databases of smokers who suffered injuries treated with and without surgery. Research published previously shows the link between cigarette use, slow healing and infections post-surgery. Nicotine collapses the body’s small blood vessels, and can affect the body’s circulation. Smoking may also have an impact on osteoblasts and osteoclasts.

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There is a 12 percent higher chance of an open fracture improperly healing in a smoker compared to a nonsmoker, and a 15 percent higher chance a smoker who fractures her or his tibia will not heal properly.(1)

Predicting menopause earlier may help slow bone loss
Along the same lines, a new method to predict menopause as many as two years earlier could help in slowing bone loss and cardiovascular disease in women, according to a recent study.(2) The method is a formula that tracks hormone levels, rather than irregular menstrual bleeding, and can bring about earlier interventions to reduce bone loss that starts as early two years prior to a woman’s final period.

The assumption was that the associations of serum sex steroid and follicle stimulating hormone (FSH) levels with change of bone mineral density (BMD) across the complete menopausal transition are incompletely understood. The outcome measures were the decline of annualized lumbar spine (LS) and femoral neck (FN) BMD measures. The conclusion was that higher estradiol (E2) levels and lower FSH levels were associated with lower rates of lumbar spine (LS) bone loss in some but not all menopausal transition phases. The femoral neck (FN) associations were weaker and inconsistent. This is important as women experience rapid bone loss within the first four to eight years of menopause, according to the National Institutes of Health.(3)

Treat-to-target for osteoporosis
Current clinical practice guidelines identify patients at high risk for fracture who are expected to benefit from pharmacological therapy and suggest ways to monitor for effectiveness of therapy. There is no clear guidance, however, on when fracture risk has been reduced to an acceptably low level.

As a result, some patients at low risk for fracture may be treated for longer than necessary, while others at high risk for fracture may have treatment halted when they might benefit from continuance of the same treatment or an alteration to a more potent therapeutic agent. The reason for this statement was to describe the potential clinical utility of developing a “treat-to-target” strategy for the management of patients with osteoporosis. The group recommended that a task force of clinicians, clinical investigators, and other stakeholders in the care of osteoporosis explore the options, review the evidence, and identify additional areas for investigation to establish osteoporosis treatment targets.(4)

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Data from large, prospective, randomized, placebo-controlled registration trials for currently available osteoporosis therapies were analyzed for commonalities of correlations between easily measured endpoints and fracture risk. The consensus process was that osteoporosis experts, professional organizations, and patient care advocates were involved in the process of developing consensus on easily measurable osteoporosis treatment targets supported by the best available evidence and likely to be accepted by clinicians and patients in the care of osteoporosis. The conclusions were that a treat-to-target strategy for osteoporosis offers the potential of improving osteoporosis care by reducing the burden of osteoporotic fractures and limiting adverse effects of therapy.(4)

Position of the Academy of Nutrition and Dietetics: oral health and nutrition
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The new Position of the Academy of Nutrition and Dietetics on oral health and nutrition. It is the position of the Academy of Nutrition and Dietetics that nutrition is an integral component of oral health. The Academy supports the integration of oral health with nutrition services, education, and research. Collaboration between dietetics practitioners and oral health care professionals is recommended for oral health promotion and disease prevention and intervention.(5) Visit the link for the entire report!!

Consensus reports about possible link between periodontitis and other systemic diseases
Last, but not least, is the new report on the oral-systemic link. The American Academy of Periodontology (AAP), in collaboration with the European Federation of Periodontology (EFP), recently published a series of consensus reports that analyze the scientific evidence linking periodontal disease, specifically periodontitis, to other systemic diseases, including diabetes, cardiovascular disease and adverse pregnancy outcomes. The full reports can be found online.(6) They will appear in the Journal of Periodontology and the Journal of Clinical Periodontology.

References
1. Schenker ML, Scolaro JA, Yannascoli SM, Baldwin KD, Mehta S. and AhnJ. Blowing Smoke: A Meta-Analysis of Smoking on Fracture Healing and Postoperative Infection. American Academy of Orthopaedic Surgeons annual meeting, March 2013. http://www.aaos.org/news/aaosnow/apr13/clinical1.asp.
2. Crandall CJ, Tseng C-H, Karlamangla AS, Finkelstein JS, Randolph JF, Thurston RC, Huang M-H, Zheng H, and Greendale GA. Serum Sex Steroid Levels and Longitudinal Changes in Bone Density in Relation to the Final Menstrual Period JCEM 2013 98: E654-E663; doi:10.1210/jc.2012-3651.
3. Facts About Menopausal Hormone Therapy. NIH Publication No. 05-5200, Originally Printed October 2002, Revised June 2005. http://www.nhlbi.nih.gov/health/women/pht_facts.pdf.
4. Lewiecki EM, Cummings SR and Cosman F. Treat-to-target for Osteoporosis: Is Now the Time? JCEM 2013 98: 946-953; doi:10.1210/jc.2012-3680.
5. Position of the Academy of Nutrition and Dietetics: Oral Health and Nutrition. J Acad Nutr Diet. 2013;113:693-701. http://download.journals.elsevierhealth.com/pdfs/journals/2212-2672/PIIS2212267213002360.pdf.
6. Special issue: Periodontitis and Systemic Diseases - Proceedings of a workshop jointly held by the European Federation of Periodontology and American Academy of Periodontology. Co-edited by Maurizio Tonetti and Kenneth S. Kornman. The workshop was funded by an unrestricted educational grant from Colgate-Palmolive to the European Federation of Periodontology and the American Academy of Periodontology. All manuscripts were fully peer reviewed. http://www.joponline.org/toc/jop/84/4-s.

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Maria Perno Goldie, RDH, MS

To read previous RDH eVillage FOCUS articles by Maria Perno Goldie, click here.

To read more about osteoporosis and dental hygiene, click here.

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