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An investigation of the bidirectional link between osteoporosis and periodontitis

Abstract

Summary

This study investigated whether periodontitis affects systemic bone status and whether FRAX® is a screening tool for periodontal disease in elderly women. The findings showed that bone density was not influenced by periodontitis and highlighted that women with FRAX® score above the intervention threshold had greater chance to present severe periodontitis.

Purpose

This study investigated whether periodontal disease is a predictor for systemic bone loss among elderly women. The utilization of FRAX® as a screening tool for severe periodontitis was also evaluated in this population.

Methods

Current bone mineral density (BMD) for lumbar spine and proximal femur was used as an indicator of “bone status.” Number of interdental sites with severe clinical attachment loss, frequency of bleeding on probing, and percentage of tooth loss due to periodontitis represented “periodontal disease” that was tested as a predictor of bone loss in a structural equation modeling analysis involving 110 participants. The intake of antiosteoporosis medication was considered in the analysis. Four other different criteria for periodontitis classification were also tested. FRAX® for major fracture was calculated without BMD, and with intervention threshold set by age. Longitudinally, BMD changes up to 10 years were also obtained and checked for possible association with periodontitis.

Results

Periodontal disease was not a predictor for worse systemic bone status according to the different periodontal disease classifications, and was not associated with BMD changes. Antiosteoporosis medication directly predicted periodontal disease and systemic bone status. Women with FRAX® score above the intervention threshold had higher chance for periodontitis in more advanced stages: III/IV (OR = 1.13, 95% CI [1.04 to 1.22], p = 0.03).

Conclusion

Periodontal disease did not constitute a predictor for reduced systemic bone density in the studied population of elderly women. On the other hand, FRAX® demonstrated to be a useful tool to suggest periodontal evaluation. Antiresorptive medication showed benefits on periodontal and bone status.

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Acknowledgments

The authors thank the Coordination for the Improvement of Higher Education Personnel (CAPES), Brazil.

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Correspondence to D. C. Penoni.

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Penoni, D.C., Vettore, M.V., Torres, S.R. et al. An investigation of the bidirectional link between osteoporosis and periodontitis. Arch Osteoporos 14, 94 (2019). https://doi.org/10.1007/s11657-019-0643-9

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Keywords

  • Bone density
  • FRAX
  • Osteoporosis
  • Periodontitis
  • Tooth loss
  • Elderly