Original Study| Volume 22, ISSUE 6, P1184-1189.e1, June 2021

Relationship Between Oral Health and Fractures in Community-Dwelling Older Japanese Adults

Published:February 12, 2021DOI:



      To investigate the relationship between poor oral health and the incidence of fall-related fractures in older Japanese individuals.


      A 9-year prospective cohort study.

      Setting and Participants

      Participants comprised 937 community-dwelling older Japanese adults aged 70 years or older. They all lived in the Tsurugaya district, a suburban area of Sendai city, and underwent comprehensive geriatric assessment, including an oral examination, in a public facility.


      The exposure variables were related to oral health status (posterior occlusal support, number of remaining teeth, and occlusal force). The outcome measure was the incidence of fall-related fractures, which was determined by National Health Insurance data. Analyzed covariates included age, sex, medical history, smoking, alcohol drinking, educational level, depressive symptoms, cognitive impairment, physical function, body mass index, and history of falls. Statistical relationships were examined by calculating hazard ratios (HRs) at 95% confidence intervals (CIs) using the Cox proportional hazard model.


      In the multivariate analysis, the HRs of fall-related fractures were significantly higher in those with unilateral posterior occlusal support (HR, 2.72; 95% CI, 1.13-6.55) and no posterior occlusal support (HR, 2.58; 95% CI, 1.29-5.15) than in those with bilateral posterior occlusal support. The HRs (95% CIs) of fall-related fractures in individuals with 10-19 and 1-9 teeth and edentulous individuals were 1.77 (0.81-3.89), 2.67 (1.24-5.75), and 2.31 (1.01-5.28), respectively, compared to those with ≥20 teeth.

      Conclusions and Implications

      Poor oral health status is a risk factor for the incidence of fall-related fractures in community-dwelling older Japanese individuals. The findings suggest that attention should be focused on oral health status to further understand the risk of fall-related fractures among community-dwelling older adults.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Tinetti M.E.
        • Speechley M.
        • Ginter S.F.
        Risk factors for falls among elderly persons living in the community.
        N Engl J Med. 1988; 319: 1701-1707
        • Tromp A.M.
        • Smit J.H.
        • Deeg D.J.
        • et al.
        Predictors for falls and fractures in the Longitudinal Aging Study Amsterdam.
        J Bone Miner Res. 1998; 13: 1932-1939
        • Chen J.S.
        • Simpson J.M.
        • March L.M.
        • et al.
        Risk factors for fracture following a fall among older people in residential care facilities in Australia.
        J Am Geriatr Soc. 2008; 56: 2020-2026
        • Sambrook P.N.
        • Cameron I.D.
        • Chen J.S.
        • et al.
        Influence of fall related factors and bone strength on fracture risk in the frail elderly.
        Osteoporos Int. 2007; 18: 603-610
        • Rubenstein L.Z.
        Falls in older people: Epidemiology, risk factors and strategies for prevention.
        Age Ageing. 2006; 35: ii37-ii41
        • Palacios S.
        • Neyro J.L.
        • Fernández de Cabo S.
        • et al.
        Impact of osteoporosis and bone fracture on health-related quality of life in postmenopausal women.
        Climacteric. 2014; 17: 60-70
        • Taguchi Y.
        • Inoue Y.
        • Kido T.
        • Arai N.
        Treatment costs and cost drivers among osteoporotic fracture patients in Japan: A retrospective database analysis.
        Arch Osteoporos. 2018; 13: 45
        • Papadimitriou N.
        • Tsilidis K.K.
        • Orfanos P.
        • et al.
        Burden of hip fracture using disability-adjusted life-years: A pooled analysis of prospective cohorts in the CHANCES consortium.
        Lancet Public Health. 2017; 2: e239-e246
        • Lin Z.Z.
        • Wang J.J.
        • Chung C.R.
        • et al.
        Epidemiology and mortality of hip fracture among patients on dialysis: Taiwan National Cohort Study.
        Bone. 2014; 64: 235-239
        • Yamamoto T.
        • Kondo K.
        • Misawa J.
        • et al.
        Dental status and incident falls among older Japanese: A prospective cohort study.
        BMJ Open. 2012; 2: e001262
        • Yoshida M.
        • Morikawa H.
        • Kanehisa Y.
        • et al.
        Functional dental occlusion may prevent falls in elderly individuals with dementia.
        J Am Geriatr Soc. 2005; 53: 1631-1632
        • Eto M.
        • Miyauchi S.
        Relationship between occlusal force and falls among community-dwelling elderly in Japan: A cross-sectional correlative study.
        BMC Geriatr. 2018; 18: 111
        • Trevisan C.
        • Crippa A.
        • Ek S.
        • et al.
        Nutritional status, body mass index, and the risk of falls in community-dwelling older adults: A systematic review and meta-analysis.
        J Am Med Dir Assoc. 2019; 20: 569-582
        • Morrison S.
        • Simmons R.
        • Colberg S.R.
        • et al.
        Supervised balance training and Wii Fit-based exercises lower falls risk in older adults with type 2 diabetes.
        J Am Med Dir Assoc. 2018; 19: 185.e7-185.e13
        • Priebe J.
        • Wermers R.A.
        • Sems S.A.
        • et al.
        Relationship of number of missing teeth to hip fracture in elderly patients: A cohort pilot study.
        J Prosthodont. 2019; 28: 258-263
        • Wakai K.
        • Naito M.
        • Naito T.
        • et al.
        Tooth loss and risk of hip fracture: A prospective study of male Japanese dentists.
        Community Dent Oral Epidemiol. 2013; 41: 48-54
        • Hozawa A.
        • Ebihara S.
        • Ohmori K.
        • et al.
        Increased plasma 8-isoprostane levels in hypertensive subjects: The Tsurugaya Project.
        Hypertens Res. 2004; 27: 557-561
        • Komiyama T.
        • Ohi T.
        • Miyoshi Y.
        • et al.
        Association between tooth loss, receipt of dental care, and functional disability in an elderly Japanese population: The Tsurugaya Project.
        J Am Geriatr Soc. 2016; 64: 2495-2502
        • Kosaka T.
        • Kida M.
        • Kikui S.
        • et al.
        Factors influencing the changes in masticatory performance: The Suita Study.
        JDR Clin Trans Res. 2018; 3: 405-412
        • Brink T.L.
        • Yesavage J.A.
        • Lum O.
        • et al.
        Screening tests for geriatric depression.
        Clin Gerontol. 1982; 1: 37-43
        • Folstein M.F.
        • Folstein S.E.
        • McHugh P.R.
        Mini-mental state": A practical method for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Kuriyama S.
        • Hozawa A.
        • Ohmori K.
        • et al.
        Green tea consumption and cognitive function: A cross-sectional study from the Tsurugaya Project 1.
        Am J Clin Nutr. 2006; 83: 355-361
        • Stewart A.L.
        • Hays R.D.
        • Ware Jr., J.E.
        The MOS Short-Form General Health Survey. Reliability and validity in a patient population.
        Med Care. 1988; 26: 724-735
        • Ohi T.
        • Komiyama T.
        • Miyoshi Y.
        • et al.
        Maximum occlusal force and incident functional disability in older adults: The Tsurugaya Project.
        JDR Clin Trans Res. 2018; 3: 195-202
        • Yamaga T.
        • Yoshihara A.
        • Ando Y.
        • et al.
        Relationship between dental occlusion and physical fitness in an elderly population.
        J Gerontol A Biol Sci Med Sci. 2002; 57: M616-M620
        • Song-Yu X.
        • Rodis O.M.
        • Ogata S.
        • et al.
        Postural stability and occlusal status among Japanese elderly.
        Gerodontology. 2012; 29: e988-e997
        • Hashimoto M.
        • Yamanaka K.
        • Shimosato T.
        • et al.
        Oral condition and health status of elderly 8020 achievers in Aichi Prefecture.
        Bull Tokyo Dent Coll. 2006; 47: 37-43
        • Kimura M.
        • Watanabe M.
        • Tanimoto Y.
        • et al.
        Occlusal support including that from artificial teeth as an indicator for health promotion among community-dwelling elderly in Japan.
        Geriatr Gerontol Int. 2013; 13: 539-546
        • Gangloff P.
        • Louis J.P.
        • Perrin P.P.
        Dental occlusion modifies gaze and posture stabilization in human subjects.
        Neurosci Lett. 2000; 293: 203-206
        • Montero-Odasso M.
        • Sarquis-Adamson Y.
        • Song H.Y.
        • et al.
        Polypharmacy, gait performance, and falls in community-dwelling older adults. Results from the Gait and Brain Study.
        J Am Geriatr Soc. 2019; 67: 1182-1188
        • Tanaka Y.
        • Shiga H.
        Masticatory performance of the elderly as seen from differences in occlusal support of residual teeth.
        J Prosthodont Res. 2018; 62: 375-378
        • Isenring E.
        • Baker J.
        • Kerr G.
        Malnutrition and falls risk in community-dwelling older adults.
        J Nutr Health Aging. 2013; 17: 277-279
        • Kawashima Bori F.
        • Fukuhara M.
        • Masaki C.
        • et al.
        The relationship between masticatory performance and intakes of foods and nutrients in Japanese male workers: A cross-sectional study.
        J Oral Rehabil. 2020; 47: 1142-1149
        • Yao P.
        • Bennett D.
        • Mafham M.
        • et al.
        Vitamin D and calcium for the prevention of fracture: A systematic review and meta-analysis.
        JAMA Netw Open. 2019; 2: e1917789
        • Tan H.
        • Peres K.G.
        • Peres M.A.
        Retention of teeth and oral health-related quality of life.
        J Dent Res. 2016; 95: 1350-1357
        • Koyama S.
        • Aida J.
        • Kondo K.
        • et al.
        Does poor dental health predict becoming homebound among older Japanese?.
        BMC Oral Health. 2016; 16: 51
        • Zhao Y.L.
        • Alderden J.
        • Lind B.K.
        • Kim H.
        A comprehensive assessment of risk factors for falls in community-dwelling older adults.
        J Gerontol Nurs. 2018; 44: 40-48
        • Iinuma T.
        • Arai Y.
        • Fukumoto M.
        • et al.
        Maximum occlusal force and physical performance in the oldest old: The Tokyo oldest old survey on total health.
        J Am Geriatr Soc. 2012; 60: 68-76
        • Okada T.
        • Ikebe K.
        • Kagawa R.
        • et al.
        Lower protein intake mediates association between lower occlusal force and slower walking speed: From the Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians Study.
        J Am Geriatr Soc. 2015; 63: 2382-2387
        • Ikegami N.
        • Yoo B.K.
        • Hashimoto H.
        • et al.
        Japanese universal health coverage: Evolution, achievements, and challenges.
        Lancet. 2011; 378: 1106-1115