Association Between Low Bone Mineral Density and Clinical Attachment Loss in Japanese Postmenopausal Females

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.

Smoking, Serum Albumin and 25-hydroxy Vitamin D Levels, and Bone Mineral Density Are Associated with Tooth Loss in Patients with Rheumatoid Arthritis

Objectives This study investigated factors associated with tooth loss in patients with rheumatoid arthritis (RA). Methods A total of 429 patients with RA were enrolled in the study. We examined tooth loss and clinical data. Patients were classified into two groups: a group with tooth loss (tooth loss-positive group), and a group without tooth loss (tooth loss-negative group). Patients were included in the tooth loss-positive group if they had fewer remaining teeth than the number defined by the Ministry of Health, Labour and Welfare in Japan to be the normal number teeth for that age and sex. Factors associated with tooth loss were analyzed by comparing the tooth loss-positive and loss-negative groups. Results The frequency of patients with tooth loss was 39.6%. The factors associated with tooth loss were smoking [odds ratio (OR) 1.638; 95% confidence interval (CI) 1.165-2.302], serum levels of albumin (OR 0.325; 95% CI 0.149-0.707) and 25-hydroxy vitamin D (OR 0.947; 95% CI 0.915-0.980), and total hip T score (OR 0.713; 95% CI 0.535-0.950). Conclusion This study revealed that tooth loss is associated with smoking, serum levels of albumin and 25-hydroxy vitamin D, and the total hip T score in patients with RA. Our findings may help prevent tooth loss in patients with RA.

A New Index Based on Serum Creatinine and Cystatin C Can Predict the Risks of Sarcopenia, Falls and Fractures in Old Patients with Low Bone Mineral Density

As new screening tools for sarcopenia, the serum sarcopenia index (SI) and creatinine/cystatin C ratio (CCR) had not been confirmd in a population with a high fragility fracture risk. This study aimed to evaluate whether SI and CCR indicators are useful for diagnosing sarcopenia and to determine their prediction values for future falls and fractures. A total of 404 hospitalized older adults were enrolled in this longitudinal follow-up study (mean age = 66.43 ± 6.80 years). The receiver operating curve (ROC) was used to assess the diagnostic accuracy of SI and CCR. Backward-selection binary logistic regression was applied to develop the optimal models for the diagnosis of new falls and fractures. SI had a significantly higher area under the curve (AUC) than CCR for predicting sarcopenia. The optimal models had acceptable discriminative powers for predicting new falls and fractures. Lower SI and CCR are the independent risks for sarcopenia, new falls, and fractures in the low-BMD population. SI and CCR, as easily accessible biochemical markers, may be useful in the detection of sarcopenia and in predicting the occurrence of new falls and fractures in patients with low BMD who have not previously experienced falls or fractures. However, further external validations are required.

Osteoporosis and periodontal diseases - An update on their association and mechanistic links

Periodontitis and osteoporosis are prevalent inflammation-associated skeletal disorders that pose significant public health challenges to our aging population. Both periodontitis and osteoporosis are bone disorders closely associated with inflammation and aging. There has been consistent intrigue on whether a systemic skeletal disease such as osteoporosis will amplify the alveolar bone loss in periodontitis. A survey of the literature published in the past 25 years indicates that systemic low bone mineral density (BMD) is associated with alveolar bone loss, while recent evidence also suggests a correlation between clinical attachment loss and other parameters of periodontitis. Inflammation and its influence on bone remodeling play critical roles in the pathogenesis of both osteoporosis and periodontitis and could serve as the central mechanistic link between these disorders. Enhanced cytokine production and elevated inflammatory response exacerbate osteoclastic bone resorption while inhibiting osteoblastic bone formation, resulting in a net bone loss. With aging, accumulation of oxidative stress and cellular senescence drive the progression of osteoporosis and exacerbation of periodontitis. Vitamin D deficiency and smoking are shared risk factors and may mediate the connection between osteoporosis and periodontitis, through increasing oxidative stress and impairing host response to inflammation. With the connection between systemic and localized bone loss in mind, routine dental exams and intraoral radiographs may serve as a low-cost screening tool for low systemic BMD and increased fracture risk. Conversely, patients with fracture risk beyond the intervention threshold are at greater risk for developing severe periodontitis and undergo tooth loss. Various Food and Drug Administration-approved therapies for osteoporosis have shown promising results for treating periodontitis. Understanding the molecular mechanisms underlying their connection sheds light on potential therapeutic strategies that may facilitate co-management of systemic and localized bone loss.

Association between serum IgG antibody titers against Porphyromonas gingivalis and liver enzyme levels: A cross-sectional study in Sado Island

Background

Previous studies have reported associations between nonalcoholic fatty liver disease, periodontitis, and obesity. Serum immunoglobulin G (IgG) antibody titer against Porphyromonas gingivalis, a major pathogen of periodontitis, is an established indicator of periodontal infection. However, the relationship between the antibody titer and liver enzyme levels has not been clarified yet. A study in the elderly was needed to evaluate the effect of long-term persistent bacterial infection on liver function. The objective of this study was to investigate the association between liver function and infection by P. gingivalis, and the effect of obesity on the association.

Methods

A cross-sectional study was conducted in adult outpatients visiting Sado General Hospital, in Niigata Prefecture, Japan, from 2008 to 2010. The final participants included 192 men and 196 women (mean age 68.1 years). Multivariable logistic regression analyses were performed to assess the association between the serum IgG antibody titer and the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and γ-glutamine transferase (GGT) levels.

Results

In women, serum IgG antibody titers against P. gingivalis was associated with elevated ALT, but not with AST or GGT, independent of covariates (p = 0.015). No significant association was found between the antibody titer and the elevated liver enzymes in men. The effect of obesity on the relationship between antibody titer and liver enzyme levels was not statistically significant.

Conclusions

A cross-sectional analysis of adult outpatients suggested an association between P. gingivalis infection and ALT levels in women. The effect of obesity on this association was not statistically significant.

Association between low bone mineral density and periodontitis in generally healthy perimenopausal women

BACKGROUND

The association between low bone mineral density (BMD) and periodontitis in perimenopausal women is controversial. The purpose of this study was to determine whether osteoporosis or osteopenia is associated with periodontal disease in a population of adult women.

METHODS

A sample of over-45-year-old women with or without low BMD underwent lumbar spine and hip bone densitometry and a complete periodontal examination. The extent/severity or absence of periodontal disease was noted using two different case definitions. Data were gathered on socio-economic status, medication history, systemic co-morbidities, alcohol or tobacco use as well as serum levels of calcium and vitamin D.

RESULTS

One hundred seventy three women aged between 45 and 72 years old were recruited with a mean age of 57.8 years. One hundred and three had decreased BMD (61 with osteoporosis and 42 with osteopenia) and 70 were healthy. Moderate or severe periodontitis was present in 52.6% of the women. Multivariate analysis showed a clear association between low BMD and periodontitis, but only in women above 58 years old and independent of tobacco consumption or oral hygiene.

CONCLUSION

In this sample of generally healthy perimenopausal women, low BMD was associated with clinical attachment level (CAL). Women over 58 years old with decreased BMD presented with a higher mean percentage of sites with CAL ≥ 4 mm as well as CAL ≥ 6 mm when compared to controls, independent of active smoking status or poor oral hygiene.

Trabecular bone score, a new bone quality index, is associated with severe periodontitis

BACKGROUND

The association between systemic bone loss and periodontitis remains unresolved; and the trabecular bone score (TBS) is a new index for assessing decreased bone quality. Therefore, this cross-sectional study investigated the association between TBS and severe periodontitis.

METHODS

Eight hundred and five Thai participants, aged 30 to 82 years, underwent bone quality assessment. Their mean TBS was calculated from dual-energy X-ray absorptiometry images at the L1 to L4 lumbar spine using TBS software. Each participant was classified as normal, partially degraded, or degraded TBS. Full-mouth periodontal examinations determined plaque score, probing depth, clinical attachment level (CAL), and the number of remaining teeth. The participants were classified as non-severe or severe periodontitis. Differences in periodontal parameters between the TBS groups were analyzed using one-way ANOVA. The association between TBS and severe periodontitis was assessed with multivariate binary logistic regression. For severe periodontitis, the additive interaction between TBS and oral hygiene status was also analyzed.

RESULTS

The mean CAL was 0.9-mm higher in the degraded TBS group compared with the normal TBS group. Degraded TBS was associated with severe periodontitis with an adjusted odds ratio (OR) of 2.10 (95% confidence interval [CI] = 1.03 to 4.26). The combination of degraded TBS and plaque score ≥80% increased the adjusted OR to 5.71 (95% CI = 1.15 to 28.43).

CONCLUSIONS

Degraded TBS is associated with severe periodontitis and has a synergistic effect with poor oral hygiene, suggesting monitoring decreased bone quality and good oral hygiene for promoting the periodontal-systemic health of these individuals.

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

AIM

This cross-sectional study aimed to investigate the association between skeletal bone mineral density (BMD) and periodontitis in Thai adults and elders.

METHODS

This study comprised 3282 participants aged 30-82 years. BMD was assessed at 3 skeletal sites using dual-energy X-ray absorptiometry. Each participant's BMD status was classified as normal, osteopenia or osteoporosis. Periodontal assessments were the number of remaining teeth, plaque score, probing depth and clinical attachment level (CAL). The participants were classified into no/mild or moderate/severe periodontitis groups. The mean periodontal variables between BMD categories were compared. The association between the BMD status and moderate/severe periodontitis was analyzed using binary logistic regression.

RESULTS

Among the BMD categories, the greatest mean CAL and the lowest mean number of remaining teeth were found in the osteoporosis group. The mean CAL difference between the osteoporosis and normal BMD groups was 0.3 mm. In 337 participants with a plaque score of less than 40%, there was a significant association between osteoporosis and moderate/severe periodontitis.

CONCLUSION

Skeletal BMD in the osteoporosis range was associated with moderate/severe periodontitis in individuals with fair oral hygiene, suggesting the benefit of special attention to the skeletal bone health of these individuals.

MAEA rs6815464 polymorphism and periodontitis in postmenopausal Japanese females: A cross-sectional study

OBJECTIVES

Macrophage erythroblast attacher (MAEA) is a membrane protein that regulates the development of mature macrophages by mediating attachment with erythroblasts. A polymorphism rs6815464 (C/G) in MAEA gene was reported to be associated with type II diabetes. Along with diabetes, osteoporosis shows an increased prevalence in postmenopausal females, and both diseases have been reported to be associated with periodontitis. Therefore, we explored the relevance of the MAEA polymorphism to periodontitis, bone mineral density (BMD) and haemoglobin A1c (HbA1c).

DESIGN

This was a cross-sectional study with the final sample comprised of 344 postmenopausal Japanese females. Probing pocket depth (PPD) and clinical attachment level (CAL) were measured. Genotype was determined by TaqMan assay. Blood biochemical parameters and BMD of the lumbar spine were evaluated.

RESULTS

No differences were found in age, body mass index, HbA1c, BMD, number of teeth, bone metabolism parameters between the genotypes. Mean CAL and percentage of sites with PPD or CAL ≥ 5 mm were higher in the G-allele carriers than in the non-carriers. Multiple logistic regression analyses revealed that G-allele carriage was associated with severe periodontitis (odds ratio = 3.73, 95% CI = 1.36-10.19).

CONCLUSION

Our results suggested that the MAEA gene polymorphism was independently associated with severe periodontitis.

Assessing periapical dental radiographs as a screening parameter for early indications of osteoporosis in postmenopausal periodontal patients and root surface evaluation using spectrochemical analysis

Objectives:

To assess the usefulness of periapical dental radiograph as a screening tool aimed at early signs of osteoporosis in postmenopausal periodontal patients and root surface evaluation using spectrochemical analysis.

Methods:

This study was conducted at the Department of Periodontics, Riyadh Elm University, Riyadh, Saudi Arabia, for 12 months between December 2016 and November 2017. Two groups consisted healthy postmenopausal women having chronic periodontitis and postmenopausal women having chronic periodontitis with osteoporosis. Osteoporosis were evaluated for plaque index (PI); gingival index (GI); clinical attachment level (CAL); probing pocket depth (PPD), and bone mineral density (BMD). A standardized digital dental periapical radiographs were taken for every patient. The spectrochemical analysis was carried out using the self-assembled Laser-Induced Breakdown Spectroscopy (LIBS) system used for qualitative and quantitative analysis of Calcium (Ca), Potassium (K), Phosphorus (P), Fluoride (F), and Magnesium (Mg)

Results:

There was no statistically significant difference between both groups for GI and PI. Similarly PPD and CAL were showing the difference but statistically, significant difference was only for CAL. Value of distance starting from cement enamel junction to the alveolar crest (CEJ-AC) and BMD were having a statistically significant variance between both groups. The differences between osteoporotic and control group were statistically significant regarding Ca with the mean higher in the control group. Furthermore, the variances between the groups in both K and Mg were statistically significant with higher mean in the osteoporotic group (p<0.05).

Conclusion:

The clinical, radiographic, and experimental findings of this study indicated that osteoporosis has a direct effect on the progression rate of periodontal tissue destruction and dental radiographic can be suggested as a screening tool for an early sign of osteoporosis.

Osteoporosis and Periodontitis in Postmenopausal Women: A Systematic Review

This systematic review was done to assess the strength of association between osteoporosis and chronic periodontitis in postmenopausal women, assessed by bone mineral density (BMD) and clinical attachment loss, respectively. The Pubmed, Cochrane central, EMBASE, and Google Scholar were searched from year 1990 to 2015 for studies on association between chronic periodontitis and osteoporosis. Studies measuring osteoporosis in terms of central BMD and periodontitis in terms of clinical attachment level were studied. Data were extracted and descriptive analysis was performed. Screening of 1188 articles resulted in 24 articles for review after reading the titles and abstracts. Fifteen studies were shortlisted for inclusion in systematic review. Ten of these studies showed an association between periodontitis and osteoporosis. It implies that patients with severe periodontitis should also be evaluated for systemic bone health and vice versa.

Antiresorptive agent-related osteonecrosis of the jaw in osteoporosis patients from Asian countries

Bisphosphonate (BP)-associated osteonecrosis of the jaw (ONJ) was first reported in oncology patients in 2003 and subsequently in osteoporosis patients in 2004. Since oral surgical procedures, such as tooth extraction, are also considered one of the major risk factors for ONJ, there is confusion among physicians, dentists, and patients—particularly osteoporosis patients currently taking BPs—regarding the safety of remaining on therapy surrounding these procedures. Many papers about BP-related ONJ (BRONJ) have been published to date. In addition to BRONJ, recent studies have reported an association between ONJ and the antiresorptive therapy denosumab (Dmab; a RANKL-inhibitor). BRONJ and Dmab-related ONJ are together referred to as antiresorptive agent-related ONJ (ARONJ). The pathogenesis of ARONJ still remains unknown. It is forecasted that there will be an increased incidence of patients with osteoporotic fractures and an increased number of prescriptions for antiresorptive agents in Asia in the future. However, prescriptions for antiresorptives for osteoporosis may be restricted in the Asian population as the occurrence of ARONJ may be higher as compared with those in other countries. In this review, we focused on the following topics as it pertains to the Asian osteoporotic population: the oral condition specific for osteoporosis patients; definition, staging, prevalence and incidence of ARONJ; imaging modalities for ARONJ; specific risk factors for ARONJ; prevention strategies for ARONJ, and; cooperation between physicians and dentists in the prevention of ARONJ. Ideally, the Asian Federation of Osteoporosis Societies would cooperate with one another and find more population-specific evidence for the prevention of ARONJ.

Bone Density and Clinical Periodontal Attachment in Postmenopausal Women: A Systematic Review and Meta-Analysis

Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and has been considered a risk factor for periodontal disease. The aim of this systematic review and meta-analysis was to verify the scientific evidence for the association of periodontal attachment loss with low BMD in postmenopausal women. A systematic search of the literature was performed in databases until August 2016, in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eligibility criteria included studies that compared clinical attachment loss (CAL) between postmenopausal women with low and normal BMD. Studies using similar methodology, with lower and higher risk of bias, were pooled into 3 different meta-analyses to compare CAL among women with normal BMD, osteoporosis, and osteopenia. In the first meta-analysis, mean CAL was compared among groups. In the other 2 meta-analyses, the mean percentages of sites with CAL ≥4 mm and ≥6 mm were respectively compared among groups. From 792 unique citations, 26 articles were selected for the qualitative synthesis. Eleven of the studies were appraised as presenting low risk of bias, and the association between low BMD and CAL was observed in 10 of these studies. Thirteen cross-sectional articles were included in the meta-analysis for osteoporosis and 9 in the osteopenia analysis. Women with low BMD presented greater mean CAL than those with normal BMD (osteoporosis = 0.34 mm [95% confidence interval (CI), 0.20–0.49], P < 0.001; osteopenia = 0.07 mm [95% CI, 0.01–0.13], P = 0.02). Only studies with lower risk of bias were available for the analysis of CAL severity. Women with low BMD presented more severe attachment loss, represented as mean percentage of sites with CAL ≥4 mm (osteoporosis = 3.04 [95% CI, 1.23–4.85], P = 0.001; osteopenia = 1.74 [95% CI, 0.36–3.12], P = 0.01) and CAL ≥6 mm (osteoporosis = 5.07 [95% CI, 2.74–7.40], P < 0.001). This systematic review and meta-analysis indicates that postmenopausal women with osteoporosis or osteopenia may exhibit greater CAL compared with women with normal BMD.

Association of osteoporosis and bone medication with the periodontal condition in elderly women

This study investigated whether osteoporosis and its treatment may affect periodontal condition in elderly women. The findings highlighted that women with osteoporosis had a higher chance to present severe periodontitis than women with normal bone mineral density (BMD), particularly those who were not treated for osteoporosis.

INTRODUCTION

This study investigated whether osteoporosis increases the frequency and severity of chronic periodontitis in elderly women and evaluated the influence of vitamin D and osteoporosis treatment in the periodontal condition.

METHODS

In this cross-sectional study, elderly women were selected among 1266 subjects evaluated for lumbar spine and proximal femur bone mineral density (BMD) using dual energy X-ray absorptiometry. Sociodemographic, clinical characteristics, and complete periodontal examination were recorded. Serum 25-hydroxyvitamin D levels were measured by chemiluminescence.

RESULTS

Forty-eight elderly women with normal BMD and 86 with osteoporosis were selected. Women with osteoporosis presented higher frequency of sites with clinical attachment level ≥6 mm (p = 0.003) and gingival recession ≥3 mm (p = 0.002) than those with normal BMD and were more than twice as likely to present severe periodontitis (odds ratio (OR) = 2.49, 95 % CI [1.14 to 5.43]). Osteoporotic women who were not treated for the condition had more chance to present severe periodontitis (OR = 3.16, 95 % CI [1.28 to 7.82]) than those who did use bisphosphonates (OR = 2.04, 95 % CI [0.85 to 4.89]). Among the participants who presented low levels of vitamin D, those with osteoporosis exhibited a higher chance to present severe periodontitis than those with normal BMD (p = 0.027), but the association between vitamin D levels and osteoporosis was not statistically significant after adjustment (p = 0.198).

CONCLUSIONS

Elderly women with osteoporosis have a greater chance to present periodontitis, with higher severity than those with normal BMD. Osteoporosis treatment provides protection for periodontitis.

The influence of bone mineral density and bisphosphonate therapy on the determinants of oral health and changes on dental panoramic radiographs in postmenopausal women

OBJECTIVES

The aim of this study was to assess the determinants of oral health including the number of decayed, missing, and filled teeth (DMFT) and periodontal indices in postmenopausal women with osteoporosis, osteoporosis treated with bisphosphonate therapy, and control group and to examine the correlation between dental panoramic indices (Mental Index-MI, Mandibular Cortical Index-MCI) and bone mineral density in these three groups of patients.

MATERIALS AND METHODS

The presented non-interventional study involved 120 postmenopausal women: women with osteoporosis (O) (n = 45), women with osteoporosis treated with bisphosphonates (OBP) (n = 45), and control group (C) (n = 30). DMFT, plaque, gingival and papilla bleeding index, pocket depth, clinical attachment loss, and the presence of periodontitis were evaluated for each patient. MI and MCI of all participants were measured on a dental panoramic radiograph.

RESULTS

Group OBP showed significantly higher gingival, bleeding index and deeper pocket depth than C and/or O group. No significant differences were found in MI (p = .303) or MCI (p = .06) in all the examined groups. Also, there were no significant differences between the three groups in the presence of periodontitis as well as in the DMFT index.

CONCLUSION

BP therapy could have a negative influence on periodontal health. Further, MI and MCI are not precise diagnostic tools for diagnosing low BMD in postmenopausal women.

CLINICAL RELEVANCE

BP therapy could have a negative influence on the determinants of oral health in postmenopausal women with osteoporosis.