Significant association between skeletal bone mineral density and moderate to severe periodontitis in fair oral hygiene individuals

Decreased bone mineral density is associated with an increased number of teeth with periodontitis progression: a 5-year retrospective cohort study

OBJECTIVE

Longitudinal studies on the systemic bone loss-periodontitis relationship are limited with disparate results. The aim of this study was to investigate the association between bone mineral density (BMD) and periodontitis progression, controlling for other covariables in a Thai population.

MATERIALS AND METHODS

In 2,418 participants, BMD values of the lumbar spine, femoral neck, and total hip were measured with dual-energy X-ray absorptiometry at baseline. Each participant's BMD status was classified as normal, osteopenia, or osteoporosis. Full mouth periodontal examinations on 6 sites/tooth were performed at baseline and 5-year follow-up visits. Periodontitis progression was defined as a tooth presenting an additional proximal CAL loss of ≥ 3 mm or an additional lost tooth with a baseline CAL ≥ 5 mm. The risk effects of BMD status on the number of teeth with periodontitis progression were analyzed using multivariate Poisson regression.

RESULTS

Baseline BMD status of osteoporosis was associated with an increased number of teeth with periodontitis progression in the subgroups of postmenopausal women, non-smokers, and participants with periodontitis stage III/IV with adjusted risk ratios of 1.31 (95% CI = 1.09-1.58), 1.19 (95% CI = 1.04-1.36), and 1.13 (95% CI = 1.00-1.28), respectively.

CONCLUSION

Baseline BMD in the osteoporosis range increased the risk of having a greater number of teeth with periodontitis progression in specific participant subgroups.

CLINICAL RELEVANCE

Decreased BMD is a potential factor affecting periodontitis progression risk in some individuals. Multidisciplinary approaches in educating and maintaining patients' bone-oral health may help improve their quality of life.

Association between periodontal disease and osteoporosis in postmenopausal women: A systematic review and meta-analysis

Objective

To evaluate the relationship between periodontitis and postmenopausal osteoporosis.

Methods

This research was carried out according to the principles laid down by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline statement. We searched the Web of Science, Embase, PubMed, The Cochrane Library, CNKI, VIP, and WanFang databases from inception to July 1, 2023 to collect all relevant publications, with no restrictions on publication date or Languages. Cochrane's tool for assessing RoB was used to evaluate the RoB for RCTs. The Newcastle-Ottawa Scale was used to assess the RoB for cohort studies and case-control studies. Mean differences (MD) with 95 % confidence intervals (CI) were used for analysis of continuous data. Heterogeneity was measured using the I2 statistic. Revman 5.4 software was used for the meta-analysis.

Results

28 observational studies with 19611 patients, including 5813 cases in the postmenopausal osteoporosis group and 13798 cases in the non-osteoporosis group. The studies showed that the degrees of clinical attachment loss (CAL), probing depth (PD), gingival recession (GR), simplified oral hygiene index (OHIS), and percentage of sites with bleeding on probing (BOP) in the postmenopausal osteoporosis group were higher than those in the non-osteoporosis group[CAL(MD = 0.89(mm), 95 % CI [0.48,1.30], p < 0.00001), PD (MD = 0.27(mm), 95 % CI [0.13, 0.41], p = 0.0001), GR (MD = 0.28(mm), 95 % CI [0.20, 0.35], p < 0.00001), OHIS (MD = 1.32,95 % CI [1.12,1.51], p < 0.00001), BOP(MD = 12.71(%), 95 % CI [3.24,22.18], p = 0.009)]. Eleven studies found that bone mineral density (BMD) in the postmenopausal osteoporosis group was lower than that in non-osteoporosis group (MD = -0.41(U/cm2), 95 % CI [-0.77,-0.05], p = 0.03). The combined analysis results of the studies in the two groups showed that there were no significant differences in the loss of alveolar crestal height (ACH)[(MD = -1.76(%),95%CI [-3.64,0.12], p = 0.07)].

Conclusion

Postmenopausal osteoporosis patients are more likely to suffer from periodontitis, and the condition is easily aggravated.

Periodontal Health and Disease in the Context of Systemic Diseases

During recent years, considerable progress has been made in understanding the etiopathogenesis of periodontitis in its various forms and their interactions with the host. Furthermore, a number of reports have highlighted the importance of oral health and disease in systemic conditions, especially cardiovascular diseases and diabetes. In this regard, research has attempted to explain the role of periodontitis in promoting alteration in distant sites and organs. Recently, DNA sequencing studies have revealed how oral infections can occur in distant sites such as the colon, reproductive tissues, metabolic diseases, and atheromas. The objective of this review is to describe and update the emerging evidence and knowledge regarding the association between periodontitis and systemic disease and to analyse the evidence that has reported periodontitis as a risk factor for the development of various forms of systemic diseases in order to provide a better understanding of the possible shared etiopathogenetic pathways between periodontitis and the different forms of systemic diseases.

Association between total body bone mineral density and periodontitis: A Mendelian randomization study

BACKGROUND

The purpose of the study was to examine the association between total body bone mineral density (BMD) and periodontitis using Mendelian randomization (MR) analysis.

METHODS AND MATERIALS

We used 81 single nucleotide polymorphisms (SNPs) associated with BMD at a p-value of < 5 × 10^-8 from a genome-wide association study (GWAS) of 66,628 individuals of European descent. The GWAS for periodontitis was derived from a meta-analysis of seven cohort studies that included 17,353 cases and 28,210 controls of European ancestry.

RESULTS

MR showed no association between BMD and periodontitis (odds ratio per standard deviation increment in genetically predicted BMD = 1.00; 95% confidence interval: 0.92-1.08). Leave-one-out analyses and pleiotropy-robust methods did not indicate any bias.

CONCLUSIONS

The MR study provided no evidence that BMD might be causally linked to periodontitis. Hence it may be concluded as the key finding that BMD depletion does not increase the risk of periodontitis.

Bone markers and bone mineral density associates with periodontitis in females with poly-cystic ovarian syndrome

INTRODUCTION

Studies suggest an association between poly-cystic ovarian syndrome (PCOS) and chronic periodontitis (CP), both being inflammatory conditions. However, insufficient evidence assesses the impact of this inflammation on bone metabolism and bone turnover markers (BTMs). The present study aimed to determine the association between BTMs, bone mineral density (BMD), and clinical periodontal parameters in PCOS women with CP.

MATERIALS AND METHODS

Three groups, each with 40 newly diagnosed (1) PCOS+CP, (2) PCOS alone, (3) CP alone, and fourth group (n = 20) systemically and periodontally healthy females aged 18-30 years were included in the study. Full mouth clinical periodontal parameters, C-terminal telopeptides of type I collagen (CTX), bone alkaline phosphatase (ALP), BMD and 25-hydroxyvitamin D (VD) were recorded for all.

RESULTS

Low BMD (0.89 ± 0.11 g/cm²), increased CTX levels (2.76 ± 4.64 ng/ml), decreased bone ALP levels (11.09 ± 6.86 ng/ml), higher VD levels (289.02 ± 168.28 nmol/l) and poor clinical periodontal status were observed in PCOS + CP females. BMD-spine showed weak positive correlation with CTX, bone ALP, VD (r = 0.02, r = 0.07, r = 0.15, respectively) in PCOS + CP group. ANCOVA depicted covariates had no confounding effect. Multiple regression model explained 21.0% for BMD-spine and 12.7% for BMD-femur of total variability signifying association with all measured parameters among all groups.

CONCLUSION

Enhanced inflammatory thrust by periodontitis increases CTX levels and decreases bone ALP and BMD levels in women with PCOS. Screening PCOS women for periodontal disease and vice versa may have a direct bearing on overall bone health.

Analysis of the relationship between periodontitis and osteoporosis/fractures: a cross-sectional study

BACKGROUND

Chronic periodontitis is a multifactorial inflammatory disease resulting in patients exhibiting high levels of inflammatory factors causing systemic inflammatory bone destruction that may lead to osteoporosis development. The association between periodontitis and osteoporosis has been documented; however, the findings remain unclear. This study aimed to identify the association between periodontitis and osteoporosis using a cross-sectional study design and Korean Genome and Epidemiology Study (KoGES) health examinee data.

METHODS

This cross-sectional study used epidemiological data from the KoGES during 2004-2016. Of 125,324 participants (age, 40-79 years), 9969 with periodontitis and 115,332 controls (without periodontitis) were selected. We analyzed the history of osteoporosis and fractures of all participants. All participants were examined according to age, sex, income group, obesity, smoking habits, alcohol consumption, and food intake. To analyze the odds ratio (OR) of periodontitis for those with osteoporosis and fractures, a logistic regression model was used.

RESULTS

The adjusted odds ratio (aOR) of periodontitis for osteoporosis was 2.16 (95% confidence interval [CI], 2.01-2.31; P < 0.001). The aOR of periodontitis for any fracture was 1.54 (95% CI 1.46-1.62; P < 0.001).

CONCLUSION

Osteoporosis and fractures are associated with periodontitis. Performing regular oral hygiene and examinations of bone mineral density are recommended to prevent aggravation of osteoporosis and periodontitis.

Associations between osteoporosis and risk of periodontitis: A pooled analysis of observational studies

Background

Periodontitis and osteoporosis are most popular among aging population and both conditions might be linked, even though, this suggestion still until now debated.

Objectives

A meta‐analysis on previous investigations has been used to evaluate the correlation between periodontitis and osteoporosis to determine whether osteoporosis is a local indicator of bone loss, or whether it is depending on or related to periodontitis causes.

Methods

The literature database, including but not excluding, The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and Science Citation Index Expanded, was searched in this work during Feb, 2020. We conducted the investigations contain cohort studies, cross‐sectional studies, as well as case–control studies with relative risk (RR) or odds ratio (OR) and 95% confidence intervals (CIs). Subgroup and Sensitivity analysis were also applied to identify heterogeneity sources.

Results

23 observational studies with 12 cohorts, 7 cross‐sectional and 4 case–control studies, were included, together with 2,157,037 participants. Osteoporosis patients were more exposed to periodontitis (OR, 1.96; 95% CI, 1.50–2.54). Subgroup analyses showed that the higher risk of osteoporosis in periodontitis patients exists in both cross‐sectional studies (OR, 2.17; 95% CI, 1.80–2.61) and case–control studies (OR 2.63; 95% CI, 1.69–4.09), and marginally in cohort studies (OR, 1.70; 95% CI, 1.16–2.49).

Conclusion

Review analyses have shown that osteoporosis is closely related to the increased risk of periodontitis in the future. Dental specialists better to understand the potential association between periodontitis and osteoporosis.