Osteoporosis: "A risk factor for periodontitis"

The Association of Systemic and Mandibular Bone Mineral Density in Postmenopausal Females with Osteoporosis

Background/Objectives: Osteoporosis is a common general disease that mostly affects the skeletal system, including the jawbone. There is a link between systemic and mandibular osteoporosis. This study aimed at assessing the association between systemic (lumbar spine L1-L4, femoral neck, total hip) bone mineral density (BMD) and mandible BMD sites in Romanian postmenopausal females. Methods: A total of 97 menopausal patients were studied, 62 with osteoporosis and 35 females with no osteoporosis. For each patient, dual-energy X-ray absorptiometry (DXA) assessments of BMD in the mandible, proximal femur, total hip, and lumbar spine (L1-L4) were performed. Mandibular measurements were performed using the distal forearm software, followed by manual analysis after the bone contour was defined in each case. Results: Comparing the osteoporosis and control groups, there were significant differences in BMD at each examined location. The mandibular BMD (1.125 ± 0.181506 g/cm2) in the osteoporosis group was considerably smaller than in the control group (1.35497 ± 0.244397 g/cm2). Correlations between the BMD at different sites were significant: lumbar spine and femoral neck (r = 0.738, p < 0.0001), lumbar spine and total hip (r = 0.735, p < 0.0001), lumbar spine and mandible (r = 0.506, p < 0.0001), femoral neck and total hip (r = 0.891, p < 0.0001), femoral neck and mandible (r = 0.482, p < 0.0001), and total hip and mandible (r = 0.466, p < 0.0001). Conclusions: There were correlations between mandible BMD and lumbar spine, femoral neck, and total hip BMD, suggesting that osteoporosis affects mandibular bone density. BMD assessments at common locations may help predict mandibular BMD and the probability of osteoporosis.

Implication of thyroid function in periodontitis: a nationwide population-based study

Possible links between periodontitis and various cardiometabolic and autoimmune diseases have been advocated on the basis of chronic inflammation or oxidative stress. However, the association between periodontitis and thyroid dysfunction is under-researched. Participants without previous thyroid disease or ongoing thyroid-related medication were included from a nationwide population-level survey. Participants were categorized into tertiles of thyroid stimulating hormone (TSH) levels (first tertile < 1.76 mIU/L; second tertile 1.76-2.83 mIU/L; third tertile > 2.83 mIU/L), and periodontal condition was assessed using the Community Periodontal Index. Of the total of 5468 participants, 1423 had periodontitis (26%). A significant difference in the weighted prevalence of periodontitis according to TSH tertiles was observed, with the highest prevalence in the first tertile (26.5%) and the lowest prevalence in the third tertile (20.9%, p = 0.003). Subjects in the first TSH tertile had higher odds for periodontitis than those in the third tertile (OR 1.36, 95% CI 1.10-1.68; p for trend = 0.005) after adjusting for covariates. This association was consistent across subgroups and within sensitivity analyses among subjects without specific factors affecting thyroid function or diseases reported to be related to periodontitis. The present study demonstrated that low TSH levels were associated with significantly higher odds for periodontitis.

Methylsulfonylmethane Increases the Alveolar Bone Density of Mandibles in Aging Female Mice

Methylsulfonylmethane (MSM) is a naturally occurring anti-inflammatory compound that effectively treats multiple degenerative diseases such as osteoarthritis and acute pancreatitis. Our previous studies have demonstrated the ability of MSM to differentiate stem cells from human exfoliated deciduous (SHED) teeth into osteoblast-like cells. This study examined the systemic effect of MSM in 36-week-old aging C57BL/6 female mice in vivo by injecting MSM for 13 weeks. Serum analyses showed an increase in expression levels of bone formation markers [osteocalcin (OCN) and procollagen type 1 intact N-terminal propeptide (P1NP)] and a reduction in bone resorption markers [tartrate-resistant acid phosphatase (TRAP) and C-terminal telopeptide of type I collag (CTX-I)] in MSM-injected animals. Micro-computed tomographic images demonstrated an increase in trabecular bone density in mandibles. The trabecular bone density tended to be higher in the femur, although the increase was not significantly different between the MSM- and phosphate-buffered saline (PBS)-injected mice. In mandibles, an increase in bone density with a corresponding decrease in the marrow cavity was observed in the MSM-injected mice. Furthermore, immunohistochemical analyses of the mandibles for the osteoblast-specific marker - OCN, and the mesenchymal stem cell-specific marker - CD105 showed a significant increase and decrease in OCN and CD105 positive cells, respectively. Areas of bone loss were observed in the inter-radicular region of mandibles in control mice. However, this loss was considerably decreased due to stimulation of bone formation in response to MSM injection. In conclusion, our study has demonstrated the ability of MSM to induce osteoblast formation and function in vivo, resulting in increased bone formation in the mandible. Hence, the application of MSM and stem cells of interest may be the right combination in alveolar bone regeneration under periodontal or other related diseases that demonstrate bone loss.

Correlations between periodontal disease, mandibular inferior cortex index and the osteoporotic fracture probability assessed by means of the fracture risk assessment body mass index tool

Background

The aim was to examine correlations between radiological signs of chronic periodontitis, Mandibular Inferior Cortex (MIC) index and osteoporotic fracture probability based on the FRAX BMI tool.

Methods

The material comprised 422 panoramic radiographs taken in patients aged 40–89, 270 females and 152 males. The severity of chronic periodontitis and resorption of mandibular inferior cortex based on MIC index were assessed. A diagnostic survey was conducted to estimate 10-year major and hip osteoporotic fracture probability (MOFP, HOFP) by means of the FRAX BMI tool - an algorithm that allows to calculate osteoporotic fracture probability based on assessing bone fracture risk factors knowing only BMI value.

Results

The conducted analysis based on U Mann-Whitney test revealed that mean 10-year MOFP was significantly higher (p = 0.00) in women than in men. Mean 10-year MOFP in females was 4.8% (SD = 3.95%) and in males 3.21% (SD = 2.35%). Mean 10-year HOFP in women was 1.35% (SD = 2.07%) and was significantly higher (p = 0.03) than in men – 0.79% (SD = 1.18%).MOFP is significantly higher in patients with moderate and severe periodontitis than in those with mild periodontitis. Significant difference between MIC values and MOFP (p = 0.00) and HOFP (p = 0.00) was found. Osteoporotic fracture probability was significantly higher in patients with MIC stages C2 and C3 than C1.

Conclusions

The FRAX BMI tool with radiological evaluation of periodontal disease severity and MIC index may be used in dental practice in determining individual risk of osteoporotic fracture in females and provide new opportunities of selecting those potentially more prone to such fractures.

Trial registration

The approval of the local bioethics committee was obtained (KE-0254/107/2017).

Evaluating the possible association between systemic osteoporosis and periodontal disease progression in postmenopausal women

To evaluate the association between systemic osteoporosis and periodontal diseases in postmenopausal women. A total of 300 women aged (50-70 years) were divided into an osteoporotic (OP) group (n = 150) and non-osteoporotic (NOP) group (n = 150) depending on BMD measured using (DXA) at the femoral neck and lumbar spine. Periodontal examination including PI, GI, PPD, and CAL was measured. A standard digital dental panoramic radiograph was taken for each patient and analyzed using specially developed software graphic program to assess the alveolar bone level and BMD. Elemental analysis of root surfaces of extracted teeth was done for detecting Ca, P, F, Mg, and K using (LIBS). Results showed the differences between both groups were not statistically significant in PI, GI, and PPD. A statistically significant difference was found between both groups in CAL, the distance between CEJ-AC and alveolar bone density. Elemental analysis of the root surfaces revealed that Ca was statistically significantly less in the OP group while the differences between both groups regarding F and P were not statistically significant. Mg and K found to be significantly more in the OP group than in the NOP group. To conclude osteoporosis is certainly a risk factor for periodontal disease and seems to plays a vital role in disease progression.

Calcitonin receptor gene polymorphisms at codon 447 in patients with osteoporosis and chronic periodontitis in South Indian population - An observational study

Context:

Chronic periodontitis and osteoporosis are multifactorial diseases which share common risk factors. Interactions between genetic and other factors determine the likely hood of osteoporotic fractures and chronic periodontitis. Calcitonin receptor (CTR) gene polymorphism is one of the important factors which contribute to the development of osteoporosis and chronic periodontitis.

Aims:

This study highlights the association of CTR gene polymorphisms at codon 447 in patients with osteoporosis and chronic periodontitis and healthy controls in south Indian population.

Settings and Design:

The study was designed as a case–control retrospective, observational clinical trial which was conducted to assess the role of CTR gene polymorphism in patients with osteoporosis and periodontitis as well as in healthy controls.

Materials and Methods:

A total of 50 subjects were taken into the study comprising of 20 healthy and 30 osteoporotic subjects with chronic periodontitis between the age group of 30–55 years. Within the limitations of our study, only 50 subjects were taken in the study due to the strict sampling method (Patients who were just diagnosed with osteoporosis and periodontitis and hence not taking any medication). 2 ml of blood sample was collected in ethylenediamine tetra acetic acid containing vials, and polymerase chain reaction was run to identify CTR gene polymorphism.

Statistical Analysis Used:

Statistical analysis was done by student t-test. Pertaining to C > T allele pattern there was a significant difference between the test and control group.

Results:

A significant difference was observed between the test and control group in relation to the C > T allele pattern. Patients showing TT genotype distribution had greater periodontal destruction and lower bone-mineral density compared to CT genotype distribution followed by CC genotype distribution indicating TT homozygotes are more prone to the development of osteoporosis with increased risk of fracture and loss of alveolar bone. Males and females showed equal susceptibility to osteoporosis and chronic periodontitis.

Conclusions:

CTR polymorphism at codon 447 may be associated with osteoporosis and chronic periodontitis

Comparison of bone mineral density among pre- and post-menopausal women with and without chronic generalized periodontitis

Background

There have been a very limited number of studies regarding the assessment of bone mineral density (BMD) using dual energy X-ray absorptiometry scan. Hence, the purpose of the study was to assess the relationship between BMD and periodontal health in three different study groups.

Materials and Methods

The study comprised of thirty female individuals who were categorized into three groups: ten premenopausal women with healthy periodontium (Group A), ten premenopausal women with generalized chronic periodontitis (Group B), and ten postmenopausal women with generalized chronic periodontitis (Group C). Number of teeth, plaque index, probing depth, clinical attachment level, interproximal alveolar bone loss, T-score for dual femur and posteroanterior (PA) spine, and BMD for dual femur and PA spine of each individual were recorded in all the three groups.

Results

The BMD and T-score of dual femur and PA spine were found to be low in Group C when compared to Group A and B which was statistically significant.

Conclusion

Postmenopausal women with generalized chronic periodontitis (Group C) exhibited severe periodontal destruction with less BMD. Hence, it is suggested that periodontitis may be a risk indicator for osteoporosis in postmenopausal women and vice versa.

Comparative Analysis of Linear and Angular Measurements on Digital Orthopantomogram with Calcaneus Bone Mineral Density

BACKGROUND

Bone remodeling is a continuous and complex process which occurs throughout life. Radiomorphometric and radioangular indices on the orthopantomogram are the predictors of bone remodeling associated with mandible. Bone mineral density is the amount of calcified tissue in a certain volume of the bone.

MATERIALS AND METHODS

Fifty normal healthy individuals within the age range of 25-55 years were included in the study. Linear measurements including mandibular cortical width (MCW) and panoramic mandibular index (PMI); and angular measurements including mandibular angle (MA) and antegonial angle (AGA) were recorded. Quantitative ultrasound bone mineral density (BMD) scan of the heel bone (calcaneus) of the same patient were also performed.

RESULTS

In our study, for both males and females, antegonial angle (AGA) had highest correlation with calcaneus bone mineral density. In the age group of less than 35 years, PMI in males, and AGA in females had highest correlation. In the age range of more than 35 years, MA in males and AGA in females had highest correlation.

CONCLUSION

There is a correlation between the mandibular bone remodelling changes and calcaneal bone mineral density in case of elder subjects and thus these parameters may be used as an inexpensive alternative screening method to assess the bone mineral density and identify individuals at risk for osteoporosis and fractures and also for dental treatment planning.

Re-evaluating the role of vitamin D in the periodontium

The importance of vitamin D in maintaining skeletal health via the regulation of calcium has long been recognized as a critical function of this secosteroid. An abundance of literature shows an association between oral bone mineral density and some measure of systemic osteoporosis and suggests that osteoporosis/low bone mass may be a risk factor for periodontal disease. Recently, nonskeletal functions of vitamin D have gained notoriety for several reasons. Many cells that are not associated with calcium homeostasis have been demonstrated to possess membrane receptors for vitamin D. These include activated T and B lymphocytes, and skin, placenta, pancreas, prostate and colon cancer cells. In addition, vitamin D "insufficiency" is a worldwide epidemic and epidemiologic evidence has linked this condition to multiple chronic health problems, including cardiovascular and autoimmune diseases, hypertension and a variety of cancers. Interestingly, there is mounting evidence connecting diminished serum levels of vitamin D with increased gingival inflammation and supporting the concept of "continual vitamin D sufficiency" in maintaining periodontal health. The ability of vitamin D to regulate both the innate and the adaptive components of the host response may play an important role in this process. This review will examine the skeletal and nonskeletal functions of vitamin D, and explore its potential role in protecting the periodontium as well as in regulating periodontal wound healing.

Zoledronate effects on systemic and jaw osteopenias in ovariectomized periostin-deficient mice

Osteoporosis and periodontal disease (PD) are frequently associated in the elderly, both concurring to the loss of jaw alveolar bone and finally of teeth. Bisphosphonates improve alveolar bone loss but have also been associated with osteonecrosis of the jaw (ONJ), particularly using oncological doses of zoledronate. The effects and therapeutic margin of zoledronate on jaw bone therefore remain uncertain. We reappraised the efficacy and safety of Zoledronate (Zol) in ovariectomized (OVX) periostin (Postn)-deficient mice, a unique genetic model of systemic and jaw osteopenia. Compared to vehicle, Zol 1M (100 µg/kg/month) and Zol 1W (100 µg/kg/week) for 3 months both significantly improved femur BMD, trabecular bone volume on tissue volume (BV/TV) and cortical bone volume in both OVX Postn^+/+ and Postn^−/− (all p<0.01). Zol 1M and Zol 1W also improved jaw alveolar and basal BV/TV, although the highest dose (Zol 1W) was less efficient, particularly in Postn^−/−. Zol decreased osteoclast number and bone formation indices, i.e. MAR, MPm/BPm and BFR, independently in Postn^−/− and Postn^+/+, both in the long bones and in deep jaw alveolar bone, without differences between Zol doses. Zol 1M and Zol 1W did not reactivate inflammation nor increase fibrous tissue in the bone marrow of the jaw, whereas the distance between the root and the enamel of the incisor (DRI) remained high in Postn^−/− vs Postn^+/+ confirming latent inflammation and lack of crestal alveolar bone. Zol 1W and Zol 1M decreased osteocyte numbers in Postn^−/− and Postn^+/+ mandible, and Zol 1W increased the number of empty lacunae in Postn^−/−, however no areas of necrotic bone were observed. These results demonstrate that zoledronate improves jaw osteopenia and suggest that in Postn^−/− mice, zoledronate is not sufficient to induce bone necrosis.

Relationship between osteoporosis and periodontal disease: review of the literature

OBJECTIVE

Osteoporosis is a skeletal disease characterized by reduction in bone mass and micro architectural changes in the bone, which leads to increased bone fragility. The gold standard for the diagnosis of osteoporosis is the measurement of bone mineral density (BMD) by dual energy x-ray absorptiometry (DXA). Periodontal disease is a chronic destructive disease which can occur in adults, young people and children. Periodontal pathogens cause inflammation of the gingiva which is called gingivitis. When periodontal tissue destruction and alveolar bone loss happen, it is called periodontitis. Since both osteoporosis and periodontal diseases are bone destructive diseases, it has been hypothesized that osteoporosis could be a risk factor for the progression of periodontal disease. The aim of this study is to review the articles assessing the relationship between osteoporosis and periodontitis

MATERIALS AND METHODS

In this review, articles were selected from PubMed between January of 1998 and June 2010. Amongst 508 articles identified from the electronic search, 17 articles were selected for a full-text reading based on the inclusion and exclusion criteria.

RESULTS

Among the 17 studies focused on, 11 studies showed a positive relation between osteoporosis and periodontal disease and the six remaining studies found no significant relation between osteoporosis and periodontal disease.

CONCLUSION

These data indicate a greater propensity to lose alveolar bone in subjects with osteoporosis, especially in subjects with preexisting periodontitis. This would indicate that osteoporosis or low systemic BMD should be considered a risk factor for periodontal disease progression.

Periodontal pharmacotherapy - an updated review

Periodontal disease is mainly associated with the activity of bacteria which adhere to the tooth surface and form specific structure of bacterial biofilm. Periodontal bacteria cause inflammation of the gums and aggressive immune response, affecting the periodontium. The first phase of initial therapy - mechanical removal of dental plaque and calculus - is necessary. If this non-surgical therapy has proved to be unsuccessful, an alternative treatment with antimicrobial agents is then considered. Pharmacotherapy is based on systemic or local antibiotics and/or antiseptics, which are applied according to the severity of the disease. A number of recent periodontal studies present some of the pharmacological agents, that are directed against bacteria or a host immune response, are often chosen as an adjunct treatment option, but none of these antimicrobials were established as 'a gold standard' in the periodontal treatment. This review provides some present recommendation of pharmacological strategies, with particular emphasis on systemic and local antimicrobial therapy of periodontal disease.

The association between renal function and tooth loss in Japanese community-dwelling postmenopausal women

OBJECTIVES

This study examined whether low renal function is associated with the number of remaining teeth among community-dwelling elderly Japanese.

BACKGROUND DATA

Many elderly individuals display both low renal function and tooth loss.

MATERIALS AND METHODS

Subjects comprised 405 randomly selected women (55-74 years old). Serum cystatin C level was used to assess renal dysfunction. Multiple linear regression analysis was used to evaluate the relationship between number of remaining teeth and serum cystatin C level, with number of remaining teeth as the dependent variable. Six variables were selected as independent variables in the final model: serum cystatin C; age; mean clinical attachment level; serum cross-linked N-telopeptide of type I collagen level; body mass index and smoking habits.

RESULTS

Multiple linear regression analysis revealed a significant relationship between number of remaining teeth and serum cystatin C level. The beta value for serum cystatin C level for the number of remaining teeth was -0.11 (p = 0.018).

CONCLUSION

This study indicates a relationship between serum cystatin C level and number of remaining teeth, suggesting that low renal function could be associated with tooth loss.