Dental care providers could play an important role in detecting osteoporosis through closer collaboration with healthcare services. Doctoral student Joanna Gullberg has been investigating but says interest from medical peers is low.

Osteoporosis means a weakening of the skeleton that can lead to bone fractures. Such injuries can cause patients great distress and are among the costliest cases for healthcare. Hip fractures, for example, can require lengthy hospital stays.

I think the doctors' scepticism is due to a high workload. They are afraid that the pressure would increase.

Joanna Gullberg

In health care environments, it is not considered economically justifiable to screen at-risk patients for osteoporosis; instead, the assessment is usually made after a first-time fracture. However, previous studies have shown that there is a connection between age-related changes in the jawbone and in other parts of the skeleton. This is where Gullberg believes that resources in dentistry can be used to detect individuals who are at risk of osteoporosis and bone fractures.

“X-rays of teeth and jaws tend to be taken regularly. Since these pictures are already taken, they could also be used for assessment of osteoporosis,” says Gullberg who has recently defended her dissertation, ‘Aspects of Osteoporosis and Fracture Risk Assessment in Primary Dental Care - Attitudes, Willingness to Pay and Evaluation of an Automated Software’.

In the dissertation, she has examined the attitude among dentists and at-risk patients to introducing an assessment of osteoporosis while attending a dental appointment. The attitude was generally positive but there were question marks. “It is about having the time and the right knowledge. Dentists wonder how they can detect the connection between the jawbone and the rest of the skeleton in terms of osteoporosis,” says Gullberg.

In a second study she used a survey to examine the willingness to pay for the dentist's assessment of the X-rays regarding risk of osteoporosis among women who are in the risk group.

Another obstacle is that there is generally a lack of established ways for dentists to contact healthcare. These are crucial to prevent the patient from slipping between the cracks, explains Gullberg has also studied software that can perform automatic analyses of the jawbone.

“It exists, but it needs further development to improve the ability in detecting patients at risk.”

The main issue seems to be the lack of interest among doctors to establish a collaboration. Gullberg wanted to carry out focus group interviews with general practitioners, but despite repeated attempts, she did not succeed in getting a group together – there was only one specialist doctor who participated and took a positive view of the proposal.

“I think the doctors' scepticism is due to a high workload. They are afraid that the pressure would increase,” adds Gullberg.

Text: Magnus Jando & Adrian Grist