Correlation between bone mineral density, vitamin D deficiency, and oral health in women with breast cancer

Breast cancer (BC) survivors treated with aromatase inhibitors (AIs) typically exhibit various pathological issues, including bone loss, poor oral health, and vitamin D deficiency. Nonetheless, chronic oral disorders are even often neglected in women with BC, and explicit indications regarding oral health screening, evaluation, and treatment to prevent cancer treatment-induced bone loss (CTIBL) are lacking. A close link between oral health status and CTIBL might be explained, in part, by the systemic inflammation that characterizes both conditions. In this scenario, the effects of vitamin D (as an inflammation down-regulator) on immune systems are widely acknowledged. Vitamin D might facilitate upregulation of MAP kinases and inhibit the NF-kB signaling pathway, with crucial implications for cytokine serum levels, the prostaglandin inflammation pathway, and the immune cell system. Vitamin D deficiency, smoking, and insufficient usage of dental floss have been found to harm oral health in women with BC receiving AIs. Consequently, vitamin D deficiency screening and supplementation and an appropriate oral rehabilitation strategy should be advised and implemented in the comprehensive therapeutic approach to women with BC treated with AIs.