Osteoporosis is a bone disease resulting in the loss of bone mass and density. It can lead to weak bones, which puts you at an increased risk of fractures.

Like many people with osteoporosis, you may wonder if it will affect your teeth. The short answer is: not directly. Since your teeth aren’t actually bones, osteoporosis itself doesn’t change your teeth’s health or composition.

Yet osteoporosis can have an indirect effect on your teeth. This is because it can cause changes to your jaw, which can affect how your teeth are held in place. In fact, osteoporosis has been associated with an increased likelihood of tooth loss for this reason.

It’s important to not only brush your teeth but also brush up on information about how osteoporosis may affect your oral health. We’ll review what to know about how teeth and bones differ, current research on how osteoporosis affects teeth, and how treatment works.

Although they do have some characteristics in common, your teeth and your bones are not made of the exact same materials. Your bones are mostly collagen and the mineral calcium phosphate. Teeth, on the other hand, consist of the following main layers:

  • enamel is the hard calcified tissue on the top (crown) of teeth that isn’t made of living cells
  • cementum is another type of hard tissue that protects a tooth’s root
  • dentin is below enamel and cementum, making up most of our teeth’s interior and providing structure
  • pulp is the innermost layer of our teeth and contains nerves and blood vessels

Osteoporosis damages your bones’ ability to produce new tissue to make up their spongy interior. People may mistake teeth for bones because the whitish enamel covering the crown of your teeth looks like bone. But unlike our bones, enamel isn’t made of living tissue.

The link between osteoporosis and tooth loss is well-established and has been the subject of many scientific studies. These include:

  • The 2009 Osteodent study measured the bone density of 651 women. Researchers found that women with osteoporosis tended to have three fewer teeth on average than the women who didn’t have the health condition.
  • A 2013 study collected data from 333 people, 27% of whom were osteoporotic — that is, they showed signs that their bones had grown weaker and brittle. The study authors concluded that having osteoporosis was “significantly correlated with reduced tooth number,” specifically for molars.
  • A more recent study from 2017 also found that postmenopausal women in South India were more likely to experience tooth loss if they had developed osteoporosis.

Researchers are pretty clear that osteoporosis and tooth loss are connected, but they are still investigating the exact nature of that connection.

A key theory for the link is that as osteoporosis progresses, your jawbone also weakens and loses some of its density. When the jawbone weakens, teeth begin to lose some of their stability. These jawbone changes may affect the alignment of teeth, which may damage their roots and cause oral health complications.

If you take medication for osteoporosis, be sure to talk with your doctor about its possible effects on your teeth. Unfortunately, medications that strengthen bones can sometimes cause damage to your jawbone.

The treatment most commonly prescribed for people with osteoporosis is bisphosphonate therapy.

Bisphosphonates, which can be administered orally (by mouth) or intravenously (through a vein), can help strengthen your bones and ward off future fractures. Many people also take calcium or vitamin D with bisphosphonates, according to the American College of Rheumatology.

But there’s a risk to your jaw and teeth when you take bisphosphonates. This type of treatment has been linked to the development of a rare degenerative complication called osteonecrosis of the jaw (ONJ).

According to the Endocrine Society, the risk of developing ONJ is highest after dental surgery. It tends to occur more frequently in people who have undergone “high-dose, long-term therapy, as might be given during cancer treatment.”

One of the most important things you can do is prioritize the health of your bones and teeth by maintaining habits that contribute to their overall well-being.

Some key factors include:

If you’re having trouble getting enough calcium or vitamin D from the foods that you eat, talk with your doctor or a nutritionist about taking a supplement. Make sure you always take supplements as directed.

Proper dental hygiene is essential for the long-term health of your teeth. The American Dental Association (ADA) recommends the following:

  • Brush your teeth thoroughly twice a day for 2 minutes per session.
  • Use toothpaste containing fluoride when brushing your teeth.
  • Clean between your teeth daily (includes flossing, interdental brushes, and others).
  • Limit your intake of sugary beverages and snacks.
  • Aim to visit your dentist for regular checkups.

Let your dentist know if you’re taking an antiresorptive agent, like a bisphosphonate, so they can accommodate it in your treatment plan — especially if you’ll be undergoing any procedures like a tooth extraction. You likely won’t need to stop taking your osteoporosis treatment or skip the procedure, according to the ADA, but your dentist may need to make some accommodations.

Know your risk

Prioritizing and keeping tabs on your oral health can be especially important if you have existing dental health concerns or if you have certain risk factors for osteoporosis.

Your chances of developing osteoporosis increase as you get older. Women tend to be at elevated risk, and the loss of estrogen that occurs with menopause can also contribute.

Learn more about osteoporosis risk factors and who should get screened.

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Currently, there’s no cure for osteoporosis, so prevention remains the best strategy. However, there are several osteoporosis management and treatment options, according to 2018 research.

Certain drugs for osteoporosis aim to prevent bone loss (antiresorptive medications) while others seek to regrow bone (anabolic medications). Both classes of drugs aim to increase bone density and lower your chance of fractures.

Depending on your specific needs and health, your doctor might advise taking the following:

  • Bisphosphonate medications. These are usually the first medication prescribed for postmenopausal women, and they work by slowing the breakdown of bone.
  • Selective estrogen receptor modulators (SERMs). This class of medications is also known as estrogen agonists. SERMS, most commonly raloxifene, are also used to treat osteoporosis in women, as well as other conditions like breast cancer.
  • Hormone replacement therapy. These drugs are synthetic versions of our naturally occurring hormones. Since loss of estrogen due to menopause can contribute to osteoporosis, estrogen therapy can help, although it’s often not the first-line treatment for osteoporosis. Testosterone therapy is sometimes used similarly for osteoporosis in men.
  • Calcitonin. This is a synthetic version of a hormone produced by your thyroid gland that regulates calcium. It comes in a nasal spray and is approved by the Food and Drug Administration (FDA) for treating osteoporosis in certain postmenopausal women.
  • Antibody medications. Also called biologics, these can slow the breakdown of bone and encourage new bone formation. The two available drugs are denosumab and romosozumab, both administered through injections.
  • Parathyroid hormone therapies. Parathyroid hormones (PTHs) increase bone density and strength, helping prevent fractures. The PTH injectable medications teriparatide and abaloparatide are both FDA-approved to treat osteoporosis.
  • Calcium and vitamin D supplements. These are essential for building and maintaining strong bones (and teeth).

Physical therapy (PT) is also often used to treat osteoporosis and aims to strengthen muscle and bone to prevent future fractures (or recover from fractures). A PT exercise regimen will be tailored specifically to your health needs. It can be done in a few minutes per day at home or at regular sessions with your physical therapist.

Teeth are not bones, so they aren’t directly affected by osteoporosis. However, osteoporosis can affect your teeth indirectly by causing changes or damage to your jawbone.

Maintaining healthy habits promotes bone and oral health in the long term. This includes not smoking, eating a balanced diet, exercising regularly, and practicing proper dental hygiene.

Treatments for osteoporosis can slow down the progression of the disease and in some cases, promote bone growth. Your dentist can work with you to address any oral complications that may occur due to osteoporosis or its treatment.