Decreased bone mineral density and periodontal management

From teeth to bone: dental caries has causal effects on osteoporosis and osteoporotic fracture

OBJECTIVES

Evidence from observational studies suggested oral diseases (periodontitis (PD) and dental caries) may increase susceptibility to bone loss. However, inherent confounding of observational studies limits causal interpretation. We aimed to conduct Mendelian randomization (MR) analysis to estimate the causal effect of oral diseases on osteoporosis (OP), bone mineral density (BMD) and fracture risk.

METHODS

We used summary-level GWAS meta-analysis data from the GLIDE consortium to identify 7 and 17 single-nucleotide polymorphisms (SNPs) for periodontitis and DMFS (the sum of Decayed, Missing, and Filled tooth Surfaces) as the instrumental variables. MR analyses of these instruments were performed on European individuals for the association with BMD of forearm, femoral neck and lumbar spine; and individuals from FinnGen consortium for OP, OP with pathological fracture, postmenopausal OP with pathological fracture, and site-specific fractures. We performed single-variable Mendelian randomization (SVMR) and multivariable Mendelian randomization (MVMR) to simultaneously assess independent causal effects of PD and DMFS on different outcomes. The estimates were primarily derived using inverse variance weighted (IVW) methods. Sensitivity analyses included weighted median, MR-egger, and Leave-one-out test.

RESULTS

In MVMR, after adjusting for PD, DMFS has a positive causal effect osteoporosis (OR = 1.165, [95% CI 1.020 to 1.331, P = 0.025]) and postmenopausal OP with pathological fracture (OR = 1.422, [95% CI 1.027 to 1.969, P = 0.034]). However, these causal relationships were not observed in the single-variable Mendelian randomization (SVMR) analysis. The causal associations were robust in various sensitivity analyses.

CONCLUSIONS

In conclusion, dental caries causally increases the risk of OP and postmenopausal OP with pathological fracture, suggesting the existence of teeth-bone axis. Proactive osteoporosis screening in patients with severe dental caries may be warranted for clinical consideration.

Perfluorooctanoic acid and its alternatives disrupt the osteogenesis and osteoclastogenesis balance: Evidence from the effects on cell differentiation process

In the present study, we investigated the effects of a representative of the per- and polyfluoroalkyl substance (PFAS) chemical group, namely perfluorooctanoic acid (PFOA), and its alternatives (perfluorobutanoic acid [PFBA] and the hexafluoropropylene oxide dimer acid [GenX]) on bone homeostasis, a process that mainly depends on osteoblast (OB) and osteoclast (OC) activities at the cellular level. C3H10T1/2 cells and bone marrow macrophages (BMMs) were respectively induced into OBs and OCs, and treated with PFOA, PFBA, and GenX at doses of 0.25, 2.5, and 25 μM. Real-time PCR, ALP activity analysis, ARS staining, and TRAP staining were performed to assess cell differentiation. To explore the indirect effects on OC differentiation, conditioned media were collected from 7-day PFAS-treated C3H10T1/2 cells during differentiation. RANKL/OPG expression and secretion levels in C3H10T1/2 cells were determined, and BMMs induced into OCs were incubated in conditioned media for two days. PFOA suppressed osteogenesis characterized by the decreased mRNA expression of OB-specific molecules, ALP activity, and calcium deposition, and promoted osteoclastogenesis as evidenced by upregulated osteoclastic genes and increased number of TRAP-positive cells. Although the PFOA alternatives did not affect early osteogenesis, calcium deposits were significantly reduced and osteoclastogenesis was facilitated. The results suggested that PFOA and its alternatives could directly disturb the balance between osteogenesis and osteoclastogenesis. In addition, PFOA and its alternatives enhanced the RANKL/OPG ratio during early OB differentiation, and more BMMs stimulated with the conditioned medium differentiated into OCs, indicating the indirect stimulation on OC differentiation by PFOA and its alternatives. These findings highlight the potential skeletal hazards of PFASs, particularly emerging alternatives that might be ignored, offering a toxicological basis for further exploration.

Bone density of the cervical, thoracic and lumbar spine measured using Hounsfield units of computed tomography - results of 4350 vertebras

INTRODUCTION

The assessment of bone density has gained significance in recent years due to the aging population. Accurate assessment of bone density is crucial when deciding on the appropriate treatment plan for spinal stabilization surgery. The objective of this work was to determine the trabecular bone density values of the subaxial cervical, thoracic and lumbar spine using Hounsfield units.

MATERIAL AND METHODS

Data from 200 patients who underwent contrast-enhanced polytrauma computed tomography at a maximum care hospital over a two-year period were retrospectively analyzed. HUs were measured with an elliptical measurement field in three different locations within the vertebral body: below the upper plate, in the middle of the vertebral body, and above the base plate. The measured Hounsfield units were converted into bone density values using a validated formula.

RESULTS

The mean age of the patient collective was 47.05 years. Mean spinal bone density values decreased from cranial to caudal (C3: 231.79 mg/cm3; L5: 155.13 mg/cm3; p < 0.001), with the highest values in the upper cervical spine. Bone density values generally decreased with age in all spinal segments. There was a clear decrease in values after age 50 years (p < 0.001).

CONCLUSIONS

In our study, bone density decreased from cranial to caudal with higher values in the cervical spine. These data from the individual spinal segments may be helpful to comprehensively evaluate the status of the spine and to design a better preoperative plan before instrumentation.

Periodontitis was associated with mesial concavity of the maxillary first premolar: a cross-sectional study

The association between the anatomical features of teeth and the pathogenesis of periodontitis is well-documented. This study aimed to evaluate the influence of the mesial concavity of the maxillary first premolar on periodontal clinical indices and alveolar bone resorption rates. Employing a cross-sectional design, in 226 patients with periodontitis, we used cone beam computed tomography(CBCT) to examine the mesial concavity and alveolar bone resorption of 343 maxillary first premolar. Periodontal clinical indicators recorded by periodontal probing in the mesial of the maxillary first premolar in patients with periodontitis. Our findings indicate that the presence of mesial concavity at the cemento-enamel junction of the maxillary first premolar was not significantly influenced by either tooth position or patient sex (p > 0.05). Nonetheless, the mesial concavity at the cemento-enamel junction of the maxillary first premolar was found to exacerbate alveolar bone resorption and the inflammatory condition (p < 0.05). We infer that the mesial concavity at the cemento-enamel junction of the maxillary first premolar may contribute to localized alveolar bone loss and accelerate the progression of periodontal disease.

Estimation of Serum 1,25-Dihydroxycholecalciferol and Tumor Necrosis Factor-α Levels in Chronic Periodontitis

BACKGROUND

Major trials in the field of periodontics include a thorough understanding of its pathophysiology and the interplay between host response and periodontal factors. Certain factors such as vitamin D play a crucial role in immune regulation and their depletion is known to contribute to the onset of periodontitis. Research efforts continue to unravel the impact of elevated pro-inflammatory cytokines like TNF-α on osteoclastogenesis in periodontitis.

MATERIALS AND METHODS

The study comprised a total of 64 participants, with 33 men and 31 women, including 32 individuals with chronic periodontitis and 32 people without the condition. ELISA was employed to determine the concentrations of TNF-α and 1,25-dihydroxycholecalciferol (1,25(OH)2D) in the participants. Clinical attachment levels, probing pocket depth, gingival bleeding index, and plaque index were meticulously measured. Subsequent to data collection, appropriate statistical tests were conducted.

RESULTS

The mean serum levels of 1,25(OH)2D in test and control groups are 173.59 ± 52.60 and 401.47 ± 99.81, respectively. The mean serum levels of TNF-α in the test and control groups are 1078.09 ± 231.51 and 204.75 ± 68.31, respectively. The TNF-α levels exhibited a statistically significant difference between test and control groups (p = 0.0001) at a 5% level of significance.

CONCLUSION

Decreased levels of 1,25(OH)2D led to increased values of periodontal parameters. There was also a significant increase in serum levels of pro-inflammatory cytokines such as TNF-α.

Review of Osteoradionecrosis of the Jaw: Radiotherapy Modality, Technique, and Dose as Risk Factors

Radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) is the cornerstone of organ-sparing or adjuvant therapy for nearly all head and neck cancers. Unfortunately, aggressive RT or CCRT can result in severe late toxicities, such as osteoradionecrosis of the jaws (ORNJ). The incidence of ORNJ is currently less than 5-6% due to advances in dental preventive care programs, RT planning systems, and RT techniques. Although numerous patient-, tumor-, and treatment-related factors may influence the incidence rates of ORNJ, RT modality (equipment), technique, and dose-volume-related factors are three of the most influential factors. This is mainly because different RT equipment and techniques have different levels of success at delivering the prescribed dose to the focal volume of the treatment while keeping the "organ at risk" safe. ORNJ risk is ultimately determined by mandibular dose, despite the RT technique and method being known predictors. Regardless of the photon delivery method, the radiobiological effects will be identical if the total dose, dose per fraction, and dose distribution within the tissue remain constant. Therefore, contemporary RT procedures mitigate this risk by reducing mandibular dosages rather than altering the ionizing radiation behavior in irradiated tissues. In light of the paucity of studies that have examined the impact of RT modality, technique, and dose-volume-related parameters, as well as their radiobiological bases, the present review aims to provide a comprehensive overview of the published literature on these specific issues to establish a common language among related disciplines and provide a more reliable comparison of research results.

Bone density of the axis (C2) measured using Hounsfield units of computed tomography

INTRODUCTION

The assessment of bone density is of great importance nowadays due to the increasing age of patients. Especially in regard to the surgical stabilization of the spine, the assessment of bone density is important for therapeutic decision making. The aim of this work was to record trabecular bone density values using Hounsfield units of the second cervical vertebra.

MATERIAL AND METHODS

The study is a monocentric retrospective data analysis of 198 patients who received contrast-enhanced polytrauma computed tomography in a period of two years at a maximum care hospital. Hounsfield units were measured in three different regions within the C2: dens, transition area between dens and vertebral body and vertebral body. The measured Hounsfield units were converted into bone density values using a validated formula.

RESULTS

A total of 198 patients were included. The median bone density varied in different regions of all measured C2 vertebrae: in the dens axis, C2 transition area between dens and vertebral body, and in the vertebral body bone densities were 302.79 mg/cm³, 160.08 mg/cm³, and 240.31 mg/cm³, respectively. The transition area from dens axis to corpus had statistically significant lower bone density values compared to the other regions (p < 0.001). There was a decrease in bone density values after age 50 years in both men and women (p < 0.001).

CONCLUSIONS

The transitional area from dens axis to corpus showed statistically significant lower bone density values compared to the adjacent regions (p < 0.001). This area seems to be a predilection site for fractures of the 2nd cervical vertebra, which is why special attention should be paid here in radiological diagnostics after a trauma.

Morphologic Mandibular Bone Changes on Panoramic Radiographs of Children and Adolescents with Congenital Heart Disease

Congenital heart disease (CHD) has effects on growth and development. However, information on how the structure of the mandibular bone is affected is limited. In the present study, we aim to compare mandibular bone structures of children affected with CHD and healthy ones through the fractal analysis method and radiomorphometric indices based on panoramic radiographs. The study consisted of 80 children (20 with cyanotic CHD, 20 with acyanotic CHD, 40 control) who were diagnosed with CHD and were treated through interventional therapy or followed up through medical therapy. Fractal dimension (FD) was performed in three different areas (angulus, corpus, and interdental bone) on 80 panoramic radiographs. Additionally, we assessed various radiomorphometric indices: mandibular cortical width (MCW), panoramic mandibular index (PMI), mandibular cortical index (MCI), and simple visual estimation (SVE). p < 0.05 was accepted as statistically significant in the analysis. Values of mean MCW, PMI, MCI, SVE, and FD measurements in children affected with CHD were found to be similar to the control group, regardless of whether they were cyanotic or acyanotic (p > 0.05). In this study, fractal analysis and radiomorphometric indices revealed no trabecular structure and mineral density changes in mandibular bone of children and adolescents with CHD compared to healthy subjects.

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.

Low bone mineral density is associated with severe periodontitis at the end of the second decade of life: A population-based study

AIM

To evaluate the association between low bone mineral density (BMD) and severe periodontitis at the end of the second decade of life.

MATERIALS AND METHODS

This population-based study analysed 2032 youngers (18-19 years old) of the RPS cohort. BMD of lumbar spine (BMD-LS) and of the whole body (BMD-WB) were assessed by dual x-ray emission densitometry. Low BMD-LS (Z-score ≤ -2) and low BMD-WB (Z-score ≤ -1.5) were correlated with severe periodontitis. The extent of periodontal disease was also evaluated as the following outcomes: proportions of teeth affected by clinical attachment loss ≥5 mm and probing depth ≥5 mm. Multivariate models by sex, education, family income, risk of alcohol dependence, smoking, plaque, bleeding index, and body mass index were estimated through logistic regression (binary outcomes) and Poisson regression (continuous outcomes).

RESULTS

The prevalence of severe periodontitis was 10.97%. Low BMD-LS (odds ratio [OR] = 2.08, confidence interval [CI] = 1.12-3.85, p = .01) and low BMD-WB (OR = 1.34, CI = 1.001-1.81, p = .04) were associated with severe periodontitis in the final multivariate models. Low BMD-LS and BMD-WB were also associated with a greater extent of periodontitis (p < .05).

CONCLUSIONS

Low BMD was found to be associated with the severity and extent of periodontitis in adolescents. Adolescents at peak bone mass age presenting low BMD are more likely to be affected by severe periodontitis.

Factors affecting decision making at reassessment of periodontitis. Part 2: interpretation of clinical findings - systemic factors

This paper is the second in a four-part series outlining treatment planning at periodontal reassessment. The first article focussed on the information that should be gathered at the reassessment appointment. Treatment can involve a range of non-surgical and surgical approaches. A variety of general, practical and local site factors can affect the choice of one option over another in choosing the most predictable treatment option. Residual periodontal probing depths can be associated with both systemic and local factors. This article (part 2) outlines systemic factors that need to be assessed when faced with residual periodontal probing depths.

Relationship between Bone Mineral Density and Oral Health Status among Iranian Women

Background:

In the present research, we aimed to evaluate dental and periodontal condition in relation to bone mineral density (BMD), to determine the possible association between oral health status and bone density.

Methods:

Fifty-nine women aged older than 30 years, who had BMD assessment, were enrolled in the study. They were given dental and periodontal examination by the means of oral hygiene index (OHI), periodontal disease index (PDI), and decayed, missing, and filled teeth (DMFT). Participants answered a questionnaire regarding oral hygiene condition, socio-economic status, and physical activity level. Their BMD using dual X-ray energy absorptiometry in femoral and spinal regions was also recorded.

Result:

In this research, there was a negative correlation between DMFT and T-score of spine and femur but not with Z-scores. There was no association found between PDI and T-scores or Z-scores for BMD (P > 0.05). In addition, there was a significant negative correlation between number of missing teeth and T-score of both femoral and spinal regions; however, such an association was not found with Z-scores. In addition, a strong positive correlation was observed between OHI and DMFT.

Conclusions:

This investigation suggests a negative association between bone mineral status and oral health condition regarding DMFT and number of missing teeth. It could be concluded that inadequate bone mass could coexist with higher number of missing teeth or a worse oral health condition; nevertheless, further studies are required to assess these relationships precisely.

Effects of Bone Fragility and Antiresorptive Drugs on Periodontal Disease and Tooth Loss: A Longitudinal Study

This longitudinal study aimed to elucidate whether systemic bone fragility predicts severe periodontal clinical attachment loss (CAL) and tooth loss over the years and to test the influence of bone medication and periodontal maintenance in these relationships. Elderly women were evaluated for bone mineral density (BMD) and for fracture risk assessment (FRAX) in a cross-sectional analysis and retrospective follow-up (6- and 10-y periods). Data on BMD and FRAX were used as indicators of bone fragility in structural equation modeling. Periodontal examination and data on postmenopausal tooth loss were recorded. Multivariate Poisson regression models with robust covariance were used to estimate relative risk (RR) and 95% CI of BMD and FRAX for sites with CAL ≥6 mm and for tooth loss. The cross-sectional analysis included 134 women aged 65 to 80 y, and from them 71 and 49 women had available data for analysis in the 6- and 10-y follow-up periods, respectively. Bone fragility predicted severe CAL over 10 y (e.g., femoral neck: 10-y analysis, β = -0.389, P = 0.005; cross-sectional, β = -0.190, P = 0.004); however, this association did not remain significant when the use of bone medication was evaluated. Poisson regression showed that a better skeletal condition was associated with a lower risk of severe periodontal disease and tooth loss (cross-sectional femoral neck: RR = 0.08, P < 0.001; RR = 0.03, P < 0.001, respectively) when not adjusted for bone medication and periodontal maintenance. The receiver operating characteristic curve suggested that women with osteoporosis should be referred for periodontal assessment (sensitivity = 71.0%, specificity = 70.0%). Bone fragility is a relevant longitudinal predictor of severe periodontal disease and tooth loss among elderly women. The use of bisphosphonates improved the bone condition as well as the periodontal status. Periodontal maintenance also minimized the negative impact of low BMD on teeth-supportive tissues in the studied population. Knowledge Transfer Statement: The results of this study present evidence that the management of bone fragility and osteoporosis may be important in the prevention of periodontal attachment loss and future tooth loss. Besides the antiresorptive effects of the antiosteoporosis drugs on systemic bone conditions, these medications may protect periodontal tissues. The interaction of health care professionals such as dentists and physicians represents a key role for the approach to women's health, especially in an aging world.

Effect of 1α, 25-dihydroxyvitamin D3 on the osteogenic differentiation of human periodontal ligament stem cells and the underlying regulatory mechanism

1α, 25-dihydroxyvitamin D3 (1,25-D3), an active vitamin D metabolite, is a well-known regulator of osteogenic differentiation. However, how 1,25-D3 regulates osteogenic differentiation in human periodontal ligament stem cells (hPDLSCs) remains to be fully elucidated. The present study aimed to clarify this issue through well-controlled in vitro experiments. After hPDLSCs were treated with 1,25-D3, immunofluorescence and western blotting were used to detect the expression of vitamin D receptor; Cell Counting Kit-8 and western blotting were used to assay the cell proliferation ability. Alkaline phosphatase staining, Alizarin Red staining and western blotting were used to detect the osteogenic differentiation. It was found that treating hPDLSCs with 1,25-D3: i) Inhibited cell proliferation; ii) promoted osteogenic differentiation; iii) upregulated the expression of transcriptional coactivator with PDZ-binding motif (TAZ), an important downstream effector of Hippo signaling that has been demonstrated to be involved in the osteogenic differentiation of stem/progenitor cells; and iv) that co-treatment of TAZ-overexpressing hPDLSCs with 1,25-D3 synergistically stimulated the expression of osteogenic markers. These results suggested that the induction of osteogenic differentiation promoted by 1,25-D3 in hPDLSCs involves, at least in part, the action of TAZ.

CTHRC1 promotes osteogenic differentiation of periodontal ligament stem cells by regulating TAZ

Collagen triple helix repeat containing 1 (CTHRC1) is associated with bone metabolism. Alveolar bone has an ability to rapidly remodel itself to adapt its biomechanical environment and function. However, whether CTHRC1 is expressed in alveolar bone tissue and the role of CTHRC1 in alveolar bone remodeling remain unclear. We used orthodontic tooth movement (OTM) rat model to study the effects of CHTRC1 in alveolar bone remodeling in vivo. We found that CTHRC1 was expressed in normal physiological condition of osteocytes, bone matrix, and periodontal ligament cells in rat. During the OTM, the expression of CTHRC1, Runx2 and TAZ were increased. We further studied the effects of CTHRC1 on osteogenic differentiation of human periodontal ligament stem cells in vitro. CTHRC1 can positively regulate the expression of TAZ and osteogenic differentiation markers like Col1, ALP, Runx2 and OCN. Overexpression of CHTRC1 increased osteogenic differentiation of PDLSCs, which could be abolished by TAZ siRNA. Our results suggest that CTHRC1 plays an important role in alveolar bone remodeling and osteogenic differentiation of PDLSCs.

Increased risk of incident osteoporosis and osteoporotic fracture in tuberculosis patients: a population-based study in a tuberculosis-endemic area

The occurrence of osteoporosis in tuberculosis, a chronic infection, has rarely been evaluated. In this study, we found significantly higher incidence rates of osteoporosis (Adjusted hazard ratio (AHR) 1.82) and osteoporotic fracture (AHR 2.33) in tuberculosis patients than matched cohorts, which suggest that osteoporosis screening should be considered in tuberculosis patients' follow-up program. The aim of this study is to determine the occurrence of incident osteoporosis in patients who completed anti-tuberculosis (TB) treatment.

INTRODUCTION

Chronic inflammatory disorders are associated with an increased risk of osteoporosis. Although TB is an infectious disease characterized by systemic inflammatory responses, the impact of active TB on incident osteoporosis is unclear. We used the Taiwan National Health Insurance Research Database to investigate the association between history of active TB and incident osteoporosis and osteoporotic fracture.

METHODS

In this nationwide retrospective cohort study, active TB patients and their age- and sex-matched controls were identified from the National Health Insurance Research Database in Taiwan during 2000-2012. The occurrence of incident osteoporosis, osteoporotic fractures, and risk factors associated with osteoporosis among TB patients and matched controls were analyzed.

RESULTS

We observed incident osteoporosis in 2.2% (n = 86) of the TB patients and in 1.1% (n = 162) of the matched controls. The incidence rate of osteoporosis was 4.31 and 1.80 per 1000 person-years, which was significantly higher in TB patients (p < 0.001). In multivariate analysis, TB was an independent risk factor for osteoporosis. The other independent factors associated with osteoporosis were older age, female sex, chronic obstructive pulmonary disease, asthma, and lower income. Moreover, we demonstrated that the occurrence of osteoporotic fracture was significantly higher in TB patients.

CONCLUSIONS

Patients with a history of active TB have a higher incidence rate of osteoporosis and osteoporotic fracture.

Comparison of Cone Beam Computed Tomography-Derived Alveolar Bone Density Between Subjects with and without Aggressive Periodontitis

INTRODUCTION

Understanding the changes in bone density of patients affected by aggressive periodontitis could be useful in early disease detection and proper treatment planning.

AIM

The aim of this study was to compare alveolar bone density in patients affected with aggressive periodontitis and periodontally healthy individuals using Cone Beam Computed Tomography (CBCT).

MATERIALS AND METHODS

This cross-sectional study was conducted on 20 patients with a confirmed diagnosis of aggressive periodontitis. Twenty periodontally healthy patients attending the dental clinics for implant placement or extraction of impacted third molars served as controls. Alveolar bone density was measured using CBCT scanning. Comparisons between aggressive periodontitis group and controls for age and alveolar bone density of the anterior and posterior regions were performed using an independent sample t-test. Multivariable linear regression models were also performed.

RESULTS

The differences between groups in regard to age, anterior and posterior alveolar bone density was not statistically significant (p<0.05). In the posterior region, the multivariable regression model showed that bone density was not associated with age, gender or the study groups. Whereas, in the anterior region, patient's age was found to be significantly associated with bone density, p=0.014.

CONCLUSION

Alveolar bone density as measured by CBCT in aggressive periodontitis patients was not different from periodontally healthy individuals. Further studies are needed to confirm these findings.

Anthocyanin-Rich Blackcurrant Extract Attenuates Ovariectomy-Induced Bone Loss in Mice

Although several animal and cell studies have indicated that blackcurrant anthocyanins exert antioxidative and anti-inflammatory properties, which could potentially improve bone mass, the effect of blackcurrant on bone health has not been reported yet. Thus, this study was aimed to evaluate the effect of blackcurrant anthocyanins on bone mass in an estrogen deficiency mouse model. Fourteen-week-old C57BL/6J mice (n = 54) were ovariectomized or sham operated. The ovariectomized mice were divided into two groups, basal diet (OVX) or basal diet containing 1% anthocyanin-rich blackcurrant extract (OVX+BC), and sacrificed at 4, 8, and 12 weeks. Femoral bone mineral density (BMD) and trabecular bone volume by dual-energy X-ray absorptiometry and micro-computed tomography, respectively, and serum bone markers were measured. Ovariectomy significantly reduced BMD and trabecular bone volume at all time points (P < .05). Blackcurrant supplementation attenuated ovariectomy-induced bone loss measured by BMD and trabecular bone volume at 8 weeks (P = .055 and P = .057) and the effect was more pronounced at 12 weeks (P = .053 and P < .05). Ovariectomy and blackcurrant treatment did not alter serum biomarkers of bone formation and resorption. Bone marrow cells extracted from OVX mice significantly induced osteoclast-like (OCL) cell formation compared with cells from sham controls (P < .05). Blackcurrant treatment decreased the number of TRAP(+) OCL compared with OVX mice at 8 and 12 weeks (P < .05). Furthermore, blackcurrant supplementation reduced bone resorption activity when measured by resorption pit assay, compared with OVX group (P < .05). These results demonstrate that blackcurrant may be effective in mitigating osteoclast-induced postmenopausal bone loss.

Osteoporosis and Periodontitis

Osteoporosis and periodontitis are both diseases characterized by bone resorption. Osteoporosis features systemic degenerative bone loss that leads to loss of skeletal cancellous microstructure and subsequent fracture, whereas periodontitis involves local inflammatory bone loss, following an infectious breach of the alveolar cortical bone, and it may result in tooth loss. Most cross-sectional studies have confirmed the association of osteoporosis and periodontitis primarily on radiographic measurements and to a lesser degree on clinical parameters. Multiple shared risk factors include age, genetics, hormonal change, smoking, as well as calcium and vitamin D deficiency. Both diseases could also be risk factors for each other and have a mutual impact that requires concomitant management. Suggested mechanisms underlying the linkage are disruption of the homeostasis concerning bone remodeling, hormonal balance, and inflammation resolution. A mutual interventional approach is emerging with complex treatment interactions. Prevention and management of both diseases require interdisciplinary approaches and warrants future well-controlled longitudinal and interventional studies for evidence-based clinical guidelines.

Clinical and radiographic evaluation of effect of risedronate 5 mg as an adjunct to treatment of chronic periodontitis in postmenopausal women (12-month study)

Bisphosphonates are beneficial to women, after menopause, in treatment of gum diseases. In this study, significant improvement in the disease condition was found and that no further progress was noted, and no side effects were reported. Bisphosphonates can be safely and successfully be used to support oral health procedures.

INTRODUCTION

The purpose of this study was to evaluate host modulating effect of bisphosphonate adjunct with the treatment of chronic periodontitis in osteopenic and osteoporotic postmenopausal women.

METHODS

Twenty-two osteopenic and osteoporotic postmenopausal women with moderate to severe chronic periodontitis were selected for the study. On intraoral examination, periodontal parameters like probing depth (PD), clinical attachment level (CAL), Plaque Index (PI) and Gingival Index (GI) were recorded. Scaling and root planing were done. Intraoral periapical X-rays were taken, and alveolar bone density (ABD) was measured with cone beam computed tomography (CBCT), and then, medications (risedronate 5 mg once daily (OD), calcium citrate 250 mg OD, vitamin D 400 IU OD) were given. Patients were recalled for follow-up at 3, 6 and 12 months. Intraoral periapical (IOPA) X-rays were taken at 6 and 12 months and ABD was measured at baseline and 12 months.

RESULTS

There was a significant improvement in all the parameters. There was an increase of 0.02 ± 0.001 cm on CT scan and 0.38 ± 0.005 mm on IOPA in bone height over 12 months from baseline. Bone density increased by 118.56 ± 3.251 Hounsfield units (HU). There was no progress in the disease, and further bone loss was not noticed. This is in correlation with clinical parameters which showed highly significant gain in CAL (3.57 ± 0.234 mm) and reduction in PD (2.20 ± 0.229 mm)

CONCLUSIONS

Bisphosphonate therapy as an adjunct to scaling and root planing may have significant beneficial clinical effects on the periodontium of postmenopausal women with moderate to severe chronic periodontitis.

Alveolar bone loss in osteoporosis: a loaded and cellular affair?

Maxillary and mandibular bone mirror skeletal bone conditions. Bone remodeling happens at endosteal surfaces where the osteoclasts and osteoblasts are situated. More surfaces means more cells and remodeling. The bone turnover rate in the mandibular alveolar process is probably the fastest in the body; thus, the first signs of osteoporosis may be revealed here. Hormones, osteoporosis, and aging influence the alveolar process and the skeletal bones similarly, but differences in loading between loaded, half-loaded, and unloaded bones are important to consider. Bone mass is redistributed from one location to another where strength is needed. A sparse trabeculation in the mandibular premolar region (large intertrabecular spaces and thin trabeculae) is a reliable sign of osteopenia and a high skeletal fracture risk. Having dense trabeculation (small intertrabecular spaces and well-mineralized trabeculae) is generally advantageous to the individual because of the low fracture risk, but may imply some problems for the clinician.

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.

Five-year alveolar bone level changes in women of varying skeletal bone mineral density and bone trabeculation

OBJECTIVES

To investigate alveolar bone level changes in women with varying skeletal bone mineral density (BMD) and bone trabeculation.

STUDY DESIGN

In a prospective, longitudinal study of 128 women (22-75 years of age), BMD (dual x-ray absorptiometry), and periapical radiography were performed in 1996 and 2001. The mandibular trabecular bone was assessed as dense, mixed, or sparse. Mandibular alveolar bone level was measured with a Schei ruler and related to BMD (osteoporotic, osteopenic, or normal) and trabeculation.

RESULTS

After 5 years, the total bone level score was significantly decreased (P = .001). No significant differences were found in the total bone level scores between the different BMD groups. The greatest decreased total bone level score in 1996 was found in the group with dense trabeculation (0.71 in the dense group vs. 0.31 in the nondense group, P = .005), and similarly in 2001 (0.75 in the dense group vs. 0.39 in the nondense group, P = .020). Five-year changes in the total bone level scores did not differ between trabeculation groups (P = .37).

CONCLUSIONS

The small group of women with dense mandibular trabecular bone seems to suffer a greater decrease in alveolar bone height compared with other women, including women with osteoporosis.

Association between periodontal disease and osteoporosis by gender: a nationwide population-based cohort study

Periodontitis and osteoporosis are primary concerns in public health and clinical management. The aim of this study was to investigate the association between periodontitis and osteoporosis by gender.Data were retrieved from the National Health Insurance Research Database, Taiwan. A diagnosis of periodontitis was defined on the basis of subgingival curettage, periodontal flap operation, and gingivectomy (excluding those with restorative or aesthetic indications). Multiple logistic regression was used for analysis. After adjusting for age, sex, income, and geographical region, there was a significant association between periodontitis and osteoporosis among women (odds ratio: 1.96; 95% confidence interval 1.17-3.26). The association between periodontitis and osteoporosis was significant among women.

Effects of nonsurgical periodontal treatment on the alveolar bone density

The aim of this study was to evaluate the effects of nonsurgical periodontal treatment on alveolar bone density (ABD) and bone height (BH) using direct digital radiography. Nineteen patients (mean age: 36 ± 7.3 years) with generalized chronic periodontitis were examined at baseline, 90 (90 AT) and 180 (180 AT) days after nonsurgical periodontal therapy. Radiographs were taken from two sites with specific characteristics: 39 sites with probing pocket depth (PPD) ≤ 3 mm and clinical attachment level (CAL) ≤ 1 mm (shallow sites); and 62 sites with PPD ≥ 5 mm and CAL ≥ 3 mm (deep sites). The ABD was assessed considering the bone regions of interest at the alveolar bone crest (ROI I) and at the medullar bone (ROI II). The BH was assessed considering the distance from the alveolar bone crest to the cementoenamel junction. Mann-Whitney test was used for the overall demographic data, Wilcoxon test was used to compare the baseline, 90 AT and 180 AT data as well as to compare the groups and subgroups within the same evaluation period. The significance level was set at 5%. The deep sites showed a significant increase of ABD in ROI I at 90 AT (p<0.007) and at 180 AT (p<0.005). ABD decrease was seen in ROI II at 180 AT (p<0.04) while BH reduced only in shallow sites at 90 AT. In conclusion, an increase in ABD was observed in deep sites of patients with generalized chronic periodontitis. However, no significant change in alveolar BH was observed in these sites.

The ambit of periodontal reproductive endocrinology

A preface on the historical background, scope and clinical importance of the effects of reproductive endocrinology on the periodontium is presented. Furthermore, deductive explanations of intuitive observations evaluating the influence of reproductive endocrinology on the periodontium are discussed.

Rac-null leukocytes are associated with increased inflammation-mediated alveolar bone loss

Periodontitis is characterized by altered host-biofilm interactions that result in irreversible inflammation-mediated alveolar bone loss. Genetic and epigenetic factors that predispose to ineffective control of biofilm composition and maintenance of tissue homeostasis are not fully understood. We elucidated how leukocytes affect the course of periodontitis in Rac-null mice. Mouse models of acute gingivitis and periodontitis were used to assess the early inflammatory response and patterns of chronicity leading to loss of alveolar bone due to inflammation in Rac-null mice. Leukocyte margination was differentially impaired in these mice during attachment in conditional Rac1-null (granulocyte/monocyte lineage) mice and during rolling and attachment in Rac2-null (all blood cells) mice. Inflammatory responses to subgingival ligatures, assessed by changes in peripheral blood differential leukocyte numbers, were altered in Rac-null compared with wild-type mice. In response to persistent subgingival ligature-mediated challenge, Rac-null mice had increased loss of alveolar bone with patterns of resorption characteristic of aggressive forms of periodontitis. These findings were partially explained by higher osteoclastic coverage of the bone-periodontal ligament interface in Rac-null compared with wild-type mice. In conclusion, this study demonstrates that leukocyte defects, such as decreased endothelial margination and tissue recruitment, are rate-limiting steps in the periodontal inflammatory process that lead to more aggressive forms of periodontitis.