Osteoporose

Researchers have suggested that a link between osteoporosis and bone loss in the jaw. Studies suggest that osteoporosis may lead to tooth loss because the density of the bone that supports the teeth may be decreased, which means the teeth no longer have a solid foundation.

However, hormone replacement therapy may offer some protection. A study published in the August 1999 Journal of Periodontology concludes that estrogen supplementation in women within five years of menopause slows the progression of periodontal disease. Researchers have suspected that estrogen deficiency and osteopenia/osteoporosis speed the progression of oral bone loss following menopause, which could lead to tooth loss. The study concluded that estrogen supplementation may lower gingival inflammation and the rate of attachment loss (destruction of the fibers and bone that support the teeth) in women with signs of osteoporosis, thus helping to protect the teeth.

Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. Osteoporotic bones are more at risk of fracture. Osteoporosis is defined by the World Health Organization (WHO) in women as a bone mineral density 2.5 standard deviations below peak bone mass (20-year-old sex-matched healthy person average) as measured by DXA; the term "established osteoporosis" includes the presence of a fragility fracture. While treatment modalities are becoming available (such as the bisphosphonates), prevention is still considered the most important way to reduce fracture. Due to its hormonal component, more women, particularly after menopause, suffer from osteoporosis than men. In addition it may be caused by various hormonal conditions, smoking and medications (specifically glucocorticoids) as well as many chronic diseases.

SCIENTIFIC PAPERS

Bollen, A. M. (2006). "Female osteoporosis may be associated with composite endpoint of periodontal disease." J Evid Based Dent Pract 6(4): 289-90.

Dmitrieva, L. A., V. G. Atrushkevich, et al. (2006). "[Periodontal tissues state in patients with systemic osteoporosis]." Stomatologiia (Mosk) 85(5): 17-9.

ABSTRACT: The results of the study of periodontal tissues in patients with systemic osteoporosis in rheumatoid arthritis are presented. The reduction of bone density in the region of interalveolar septa, insignificant bone tissue loss of the horizontal type and pathological teeth mobility were reported.

Evio, S., L. Tarkkila, et al. (2006). "Effects of alendronate and hormone replacement therapy, alone and in combination, on saliva, periodontal conditions and gingival crevicular fluid matrix metalloproteinase-8 levels in women with osteoporosis." Oral Dis 12(2): 187-93.

ABSTRACT  OBJECTIVE: To compare the effects of hormone replacement therapy (HRT), alendronate and their combination on oral health of elderly postmenopausal women with osteoporosis. MATERIALS AND METHODS: Sixty patients, aged 65-80 years (mean 71 years), with a T-score of bone mineral density of -2.5 s.d. or less at either the lumbar spine or the femoral neck, were randomized to receive 2 mg of estradiol plus 1 mg norethisterone acetate (HRT) (n = 20), 10 mg of alendronate (n = 18), or their combination (n = 22) for 2 years. Periodontal and oral status and mouth symptoms were recorded, and salivary analyses made at the beginning and at the end of the study. Gingival crevicular fluid (GCF) matrix metalloproteinase (MMP-8) levels were determined to address destructive events in periodontal tissue. RESULTS: Resting salivary flow rate decreased by 19% (P < 0.05), and GCF MMP-8 tended to increase in the alendronate group. None of the regimens affected subjective feelings of dry or burning mouth. There were no significant changes in dental or periodontal status, stimulated flow rate or composition of saliva during the study. CONCLUSIONS: Alendronate decreased resting salivary flow rate but otherwise HRT or alendronate separately or in combination had no effect on oral health in elderly women with osteoporosis.

Gera, I. (2002). "[Osteoporosis: a risk factor for periodontal disease (literature review)]." Fogorv Sz 95(2): 49-54.

ABSTRACT  Osteoporosis is a major public health problem all over the world. Caucasian women have the highest risk. Osteoporosis affects about 10% of the total population but the prevalence among postmenopausal women is more than 30%. It had long been stated that general osteoporosis played no role in the etiology of destructive periodontitis with inflammatory nature. Nevertheless a substantial number of publications in recent years indicated just an opposite relationship. It has been shown that total body calcium and bone density was closely associated with mandibular bone density and several studies have demonstrated close relationship between edentulism and systemic osteopenia. Certain data showed clear relationship between osteoporosis and periodontal disease, and osteoporosis is considered as one of the risk factors for periodontal bone loss. Both osteoporosis and periodontal disease are chronic multifactorial diseases with many genetic and behavioral risk factors and determinants. Both diseases can be successfully controlled by eliminating several risk factors. Estrogen replacement therapy can be protective against both postmenopausal osteoporosis and severe periodontitis in postmenopausal women. Tobacco smoking and diet are also important risk factors for both diseases and genetic factors have also been identified as important risk factors in the etiology of both diseases. Recent epidemiological and clinical data provides limited but convincing evidence suggesting an association between osteoporosis and periodontal disease, and many common risk factors could have been detected in the etiology of both diseases.

Geurs, N. C. (2007). "Osteoporosis and periodontal disease." Periodontol 2000 44: 29-43.

Geurs, N. C., C. E. Lewis, et al. (2003). "Osteoporosis and periodontal disease progression." Periodontol 2000 32: 105-10.

Groen, J. J. (1972). "[Alveolar osteoporosis and atrophy as a cause of periodontal disease]." Ned Tijdschr Tandheelkd 79(11): 409-15.

Groen, J. J., J. Menczel, et al. (1968). "Chronic destructive periodontal disease in patients with presenile osteoporosis." J Periodontol 39(1): 19-23.

Hayward, M. and C. Fiedler-Nagy (1987). "Mechanisms of bone loss: rheumatoid arthritis, periodontal disease and osteoporosis." Agents Actions 22(3-4): 251-4.

Inagaki, K., Y. Kurosu, et al. (2006). "[Osteoporosis and periodontal disease in postmenopausal women: association and mechanisms]." Clin Calcium 16(2): 269-77.

ABSTRACT  Many studies have attempted to define the relationship between postmenopausal osteoporosis and periodontal disease. Most studies support a positive association between these common diseases; however, many are cross-sectional in nature, include relatively small sample sizes, and have inadequate control of potential confounding factors, such as age, gender, hormone intake, race, and smoking, limiting our understanding of the nature of the relationship between these diseases. Clinical conditions causing low estrogen environments in postmenopausal women allow T- and B-cell abnormalities, increased local production of the bone-active cytokines (i.e., Interleukin-1, -6 and -8, tumor necrosis factor [TNF]-alpha) and a rise in prostaglandin E(2), resulting in the progression of periodontitis.

Inagaki, K., Y. Kurosu, et al. (2003). "[Osteoporosis and periodontal disease in postmenopausal women]." Clin Calcium 13(5): 556-64.

ABSTRACT  Many studies have attempted to define the relationship between postmenopausal osteoporosis and periodontal disease. Most studies support a positive association between these common diseases; however, many are cross-sectional in nature, include relatively small sample sizes, and have inadequate control of potential confounding factors, such as age, gender, hormone intake, race, and smoking, limiting our understanding of the nature of the relationship between these diseases. Clinical conditions causing low estrogen environments in postmenopausal women allow increased local production of the bone-active cytokine and the progression of periodontal disease. Prospective studies are needed to confirm or refute a causal relation.

Inagaki, K. and T. Noguchi (2002). "[Osteoporosis: a risk factor in periodontal disease]." Clin Calcium12(7): 978-86.

ABSTRACT  Many studies have attempted to define the relationship between osteoporosis and periodontal disease. Most studies support a positive association between these common diseases; however, many are cross-sectional in nature, include relatively small sample sizes, and have inadequate control of potential confounding factors, such as age, gender, hormone intake, race, and smoking, limiting our understanding of the nature of the relationship between these diseases. Prospective studies are needed to confirm or refute a causal relation.

Jagelaviciene, E. and R. Kubilius (2006). "The relationship between general osteoporosis of the organism and periodontal diseases." Medicina (Kaunas) 42(8): 613-8.

ABSTRACT  Osteoporosis and periodontitis are very prevalent diseases and are most common in middle-aged and elderly women. These diseases are related as both damage bone tissue and share common risk factors. Discussions about the association between these two bone-damaging diseases began in 1960. A hypothesis was raised that systemic imbalance in bone resorption and deposition might manifest itself in the alveolar bone earlier than in other bones. When analyzing systemic and local changes in bone density, a number of issues were investigated and attempted to answer the question of whether dental osteopenia is a local manifestation of osteoporosis having similar etiology and risk factors, or it is an independent process depending primarily on factors that cause periodontal disease. Histomorphometric and microradiographic studies showed that increasing porosity of the cortical layer in mandible resulted in the decrease in bone mass. Bone strength is best expressed through bone mineral density, and it can be called a diagnostic criterion of osteoporosis. The examination of bone mineral density is called densitometry and may be performed using dual-energy x-ray absorptiometry. Orthopantomography is a method that is widely applied in odontological practice and is also informative in determining the bone density of the mandible. It can be applied when performing orthopantomographic and vertical linear measurements, as well as in determining indices in the studies of osteoporotic changes. Since many patients attend odontological clinics, nearly all of them undergo orthopantomography. This is a good possibility to investigate osteoporotic changes in the mandible, to select individuals for further studies, and to ensure clinical benefit and good treatment results.

Jeffcoat, M. K. (2000). "Preterm birth, osteoporosis, and periodontal disease." Compend Contin Educ Dent Suppl(30): 5-11; quiz 65.

ABSTRACT  The purpose of this two-part article is to review two major events in the life span of a woman. These include the putative relationship between oral health, pregnancy, and postmenopausal osteoporosis. Current knowledge about risk factors for preterm birth and for osteoporosis are discussed. The newest studies that address the relationship between oral and systemic health are also reviewed.

Jeffcoat, M. K., N. C. Geurs, et al. (2003). "Osteoporosis and periodontal bone loss." Clin Calcium 13(5): 577-81.

ABSTRACT  Osteoporosis and osteopenia are characterized by reductions in bone mass, and may lead to skeletal fragility and fracture. Until the advent and widespread use of such methodology to measure bone density, such as dual energy X-ray absorption (DXA), the definition of osteoporosis was usually made using the clinical signs of a fracture. In 1994 the World Health Organization defined osteoporosis as a bone mineral density level more than 2.5 standard deviations below the mean of young normal women (WHO, 1994). The potential inter-relationship of the two diseases will be discussed in this paper.

Khokhlova, E., A. I. Volozhin, et al. (1995). "[The periodontal status of patients with hypoestrogenemia in relation to the severity of systemic osteoporosis]." Stomatologiia (Mosk) 74(2): 31-3.

ABSTRACT   Changes in the periodontium progress in the patients with hypoestrogenemia, this progress being the slowest in patients with amenorrhea, intermediate in those subjected to oophorectomy, and the most rapid in those in the postmenopausal period. A conclusion was made that reduction of mineralisation of the bones enhances pathologic changes in the periodontium.

Krall, E. A. (2001). "The periodontal-systemic connection: implications for treatment of patients with osteoporosis and periodontal disease." Ann Periodontol 6(1): 209-13.

ABSTRACT  Osteoporosis and osteopenia may influence periodontal disease and tooth loss. Medications such as hormone replacement therapy and nutritional supplements that are used to prevent or treat osteoporosis have been evaluated for beneficial effects on oral health in a small number of human studies. Hormone replacement therapy (HRT), which slows the rate of bone loss at skeletal sites such as the hip and spine, also appears to reduce the rate of alveolar bone loss in postmenopausal women. HRT use is consistently associated with greater tooth retention and a reduced likelihood of edentulism in studies of elderly women. The number of studies on the effects of calcium or vitamin D intake on oral outcomes is limited, but suggest that higher intake levels are associated with reduced prevalence of clinical attachment loss and lower risk of tooth loss. Data from a prospective study of oral health in men show a similar association between higher calcium intake and reduced alveolar bone loss. The number of teeth with progression of alveolar bone loss over a 7-year period was significantly lower among men whose calcium intake was at least 1,000 mg per day, compared to men with a calcium intake below this level. Future studies should confirm these findings and evaluate the oral effects of new medications for osteoporosis. If confirmed, the implications for dental professionals may include an expanded array of medications for the treatment of periodontal disease and a greater emphasis on nutrition education for patients.

Krejci, C. B. (1996). "Osteoporosis and periodontal disease: is there a relationship?" J West Soc Periodontol Periodontal Abstr 44(2): 37-42.

ABSTRACT  Osteoporosis, by definition, is a generalized progressive reduction in both bone mineral and bone matrix which results in bone of normal composition but decreased mass. Functionally, osteoporotic bone is characterized by greater fragility and an increased propensity to fracture. It ranks as the most common metabolic bone disease and the most common skeletal disorder in the world. As such, it constitutes a major public health problem. Due to the extent of the disease, many have questioned its relevance to the maxilla and mandible and its possible relationship to periodontitis. The purpose of this paper is to review both osteoporosis and periodontitis and to present the research completed to date which has investigated the possible interrelationships between the two diseases.

Krook, L., J. P. Whalen, et al. (1972). "Human periodontal disease and osteoporosis." Cornell Vet 62(3): 371-91.

Lai, Y. L. (2004). "Osteoporosis and periodontal disease." J Chin Med Assoc 67(8): 387-8.

Lerner, U. H. (2006). "Inflammation-induced bone remodeling in periodontal disease and the influence of post-menopausal osteoporosis." J Dent Res 85(7): 596-607.

ABSTRACT  During physiological conditions, the skeleton is remodeled in so-called bone multi-cellular units. Such units have been estimated to exist at 1-2 x 10(6) sites in the adult skeleton. The number and activities of these units are regulated by a variety of hormones and cytokines. In post-menopausal osteoporosis, lack of estrogen leads to increased numbers of bone multi-cellular units and to uncoupling of bone formation and bone resorption, resulting in too little bone laid down by osteoblasts compared with the amount of bone resorbed by osteoclasts. Inflammatory processes in the vicinity of the skeleton, e.g., marginal and apical periodontitis, will affect the remodeling of the nearby bone tissue in such a way that, in most patients, the amount of bone resorbed exceeds that being formed, resulting in net bone loss (inflammation-induced osteolysis). In some patients, however, inflammation-induced bone formation exceeds resorption, and a sclerotic lesion will develop. The cellular and molecular pathogenetic mechanisms in inflammation-induced osteolysis and sclerosis are discussed in the present review. The cytokines believed to be involved in inflammation-induced remodeling are very similar to those suggested to play crucial roles in post-menopausal osteoporosis. In patients with periodontal disease and concomitant post-menopausal osteoporosis, the possibility exists that the lack of estrogen influences the activities of bone cells and immune cells in such a way that the progression of alveolar bone loss will be enhanced. In the present paper, the evidence for and against this hypothesis is presented.

Lundstrom, A., J. Jendle, et al. (2001). "Periodontal conditions in 70-year-old women with osteoporosis." Swed Dent J 25(3): 89-96.

ABSTRACT  The aim of the present study was to examine the periodontal conditions in an age cohort of 70-year-old women and compare an osteoporosis group with a control group with normal bone mineral density. 210 women 70 years old and randomly sampled from the population register of the community of Linkoping were examined. Bone mineral density (BMD) of the hip was measured by dual energy X-ray absorptiometry. 19 women were diagnosed with osteoporosis (BMD below 0.640 g/cm2 in total hip). 15 of them accepted to participate in the study. As a control group 21 women with normal bone mineral density (BMD exceeding 0.881 g/cm2) were randomly selected from the initial population. The clinical examination included registration of the number of remaining teeth, dental plaque and periodontal conditions. The radiographic examination included a dental panorama and vertical bite-wing radiographs. The subjects also answered a questionnaire about their general health, age at menopause, concurrent medication, smoking and oral hygiene habits. The results from this study showed no statistically significant differences in gingival bleeding, probing pocket depths, gingival recession and marginal bone level between the women with osteoporosis and the women with normal bone mineral density. In conclusion, the present randomly selected and controlled study of osteoporotic and non-osteoporotic women, showed no statistically significant differences in periodontal conditions or marginal bone level. As periodontitis as well as osteoporosis are associated with age, our study of a well-defined age cohort is of interest, but the results should be interpreted with caution since the compared groups are small.

Maksimovskii Iu, M., A. I. Moshchil, et al. (1991). "[Periodontal status in generalized osteoporosis in women with ovarian functional insufficiency]." Stomatologiia (Mosk) 70(1): 24-6.

ABSTRACT  Enhanced atrophic processes in periodontal tissues were revealed in women with inadequate ovarian function (primary amenorrhea, ovariectomy, climax), examined by clinical methods and by determining their periodontal inflammation index, hygienic index, gingival fluid level, and by x-ray methods. The findings correspond to generalized osteoporosis signs; this condition was detected by single-photon absorptiometry and ultrasonic osteometry.

Mohammad, A. R., M. Brunsvold, et al. (1996). "The strength of association between systemic postmenopausal osteoporosis and periodontal disease." Int J Prosthodont 9(5): 479-83.

ABSTRACT  This cross-sectional study examined the strength of association between systemic osteoporosis and periodontal status in postmenopausal non-Hispanic white women. Twenty subjects with low bone density and a spine bone density of 0.753 +/- 0.039 dual-energy x-ray absorptiometry units (g/cm2) and 22 subjects with high bone density and a spine bone density of 1.032 +/- 0.028 dual-energy x-ray absorptiometry units (g/cm2) were randomly selected from a cohort of 565 women. Periodontal assessment included Plaque Index, Gingival Index, pocket depth, gingival recession, and periodontal attachment level. There were no significant differences in Plaque Index, Gingival Index, and probing depth in both groups; however, there were significant differences in gingival recession components of periodontal attachment level in both groups. This study suggests that systemic osteoporosis may contribute to periodontal attachment loss in the form of gingival recession.

Mohammad, A. R., J. D. Jones, et al. (1994). "Osteoporosis and periodontal disease: a review." J Calif Dent Assoc 22(3): 69-75.

ABSTRACT  A review of the literature on the relationship between osteoporosis and periodontal disease is presented. Osteoporosis, a metabolic disease, and periodontal disease, which is infectious, are both major health problems with multifactorial etiologies. There is histologic and radiographic evidence from animals and humans that osteoporosis does affect alveolar bone by decreasing bone mass and trabeculation. The literature reviewed in this paper suggests, but does not yet provide conclusive evidence for, a direct relationship between osteoporosis and periodontal disease.

Ortega, R. M., A. M. Requejo, et al. (1998). "[Implication of calcium deficiency in the progress of periodontal diseases and osteoporosis]." Nutr Hosp 13(6): 316-9.

ABSTRACT  Several authors have established a relationship between osteoporosis and periodontal disease. The ageing process is associated with a loss of both oral and total bone mass. It has been shown that a reduction of bone mineralization aggravates pathological periodontal changes, resulting in less support for the teeth. The present study investigates the nutritional influences that may condition the appearance of both pathological process. Insufficient dietary calcium and a reduction in the calcium: phosphorous ratio may favour the appearance of both these conditions by promoting bone reabsorption. Bone loss affects the following in descending order: jaw bones (especially alveolar bone), cranial bones, ribs, vertebrae and long bones. Alveolar bone which has the highest rate of renewal, is affected first and consequently is the most severely affected in the long term. The role of calcium in the etiology of osteoporosis is a controversial issue. Nevertheless, its implication has been proven in numerous investigations. The effect of adequate calcium intake on dental health has formed the basis of several recent studies. These investigations have demonstrated that increased calcium intake improves the suffering of inflammatory processes and tooth mobility in patients suffering from gingivitis with haemorrhaging. Based on the results of studies which link dietary calcium and phosphorous to the risk of osteoporosis and periodontal disease, and bearing in mind that in a large proportion of the Spanish population calcium intake is below that recommended, there is a need for a general improvement of the diet. It may be of special interest to increase the calcium intake of patients suffering periodontal disease. It may also help in the prevention of osteoporosis.

Otogoto, J. and N. Ota (2003). "[Correlation between periodontal disease and osteoporosis using panoramic radiographic parameters for diagnosed osteoporosis in dental clinic]." Clin Calcium 13(5): 582-6.

ABSTRACT  The correlation between periodontal disease and osteoporosis was evaluated by comparing age, panoramic radiographic and clinical parameters of periodontal disease. Diagnosis of osteoporosis in periodontal diseased patients was evaluated by panoramic radiographic parameters (mandibular cortical width:MCW). Subjects which had more than 20 teeth and examined by panoramic radiography were untreated adults with periodontal disease who were free of other systemic disease. The following parameters were examined on panoramic X-ray film:alveolar bone loss (ABL), mandibular bone mass with the use of mandibular cortical width (MCW). ABL was significantly higher and MCW significantly lower in the postmenopausal group (>6 years after menopause). The number of teeth was significantly lower and CAL significantly higher in the postmenopausal group (>11 years after menopause). Age and ABL correlated positively in men and women. Years after menopause and ABL and MCW and CAL in the postmenopausal group were correlated positively. Women whose MCW was less than mean - 2 SD should be diagnosed with osteoporosis. Our results demonstrated that periodontal disease correlates with osteoporosis, and MCW could be useful in detecting of osteoporosis in women with periodontal disease.

Palomo, L., N. Bissada, et al. (2006). "Bisphosphonate therapy for bone loss in patients with osteoporosis and periodontal disease: clinical perspectives and review of the literature." Quintessence Int 37(2): 103-7.

ABSTRACT  As the baby boomer generation in the United States ages, more patients are using bisphosphonates for systemic bone diseases like osteoporosis. Because of their ability to inhibit bone resorption and osteoclastic activity, bisphosphonates may also be beneficial in modulating host response for periodontal disease management. This literature review examines the mechanism of action for bisphosphonates and their uses in treating periodontal disease. The dental profession should continue to evaluate this class of drugs and to closely monitor patients who are on bisphosphonate therapy.

Persson, R. E., L. G. Hollender, et al. (2002). "Assessment of periodontal conditions and systemic disease in older subjects. I. Focus on osteoporosis." J Clin Periodontol 29(9): 796-802.

ABSTRACT  BACKGROUND: Osteoporosis (OPOR) is a common chronic disease, especially in older women. Patients are often unaware of the condition until they experience bone fractures. Studies have suggested that OPOR and periodontitis are associated diseases and exaggerated by cytokine activity. Panoramic radiography (PMX) allows studies of mandibular cortical index (MCI), which is potentially diagnostic for OPOR. AIMS: i). To study the prevalence of self-reported history of OPOR in an older, ethnically diverse population, ii). to assess the agreement between PMX/MCI findings and self-reported OPOR, and iii). to assess the likelihood of having both a self-reported history of OPOR and a diagnosis of periodontitis. MATERIALS AND METHODS: PMX and medical history were obtained from 1084 subjects aged 60-75 (mean age 67.6, SD +/- 4.7). Of the films, 90.3% were useful for analysis. PMXs were studied using MCI. The PMXs were used to grade subjects as not having periodontitis or with one of three grades of periodontitis severity. RESULTS: A positive MCI was found in 38.9% of the subjects, in contrast to 8.2% self-reported OPOR. The intraclass correlation between MCI and self-reported OPOR was 0.20 (P < 0.01). The likelihood of an association between OPOR and MCI was 2.6 (95%CI: 1.6, 4.1, P < 0.001). Subjects with self-reported OPOR and a positive MCI had worse periodontal conditions (P < 0.01). The Mantel-Haentzel odds ratio for OPOR and periodontitis was 1.8 (95%CI: 1.2, 2.5, P < 0.001). CONCLUSIONS: The prevalence of positive MCI was high and consistent with epidemiological studies, but only partly consistent with a self-reported history of osteoporosis with a higher prevalence of positive MCI in Chinese women. Horizontal alveolar bone loss is associated with both positive self-reported OPOR and MCI.

Reisel, J. H. (1972). "[Clinical osteoporosis and periodontal disease. II]." Ned Tijdschr Tandheelkd 79(3): 100-2.

Renvert, S. (2003). "Destructive periodontal disease in relation to diabetes mellitus, cardiovascular diseases, osteoporosis and respiratory diseases." Oral Health Prev Dent 1 Suppl 1: 341-57; discussison 358-9.

Serhan, C. N. (2004). "Clues for new therapeutics in osteoporosis and periodontal disease: new roles for lipoxygenases?" Expert Opin Ther Targets 8(6): 643-52.

ABSTRACT  Lipoxygenase (LOX) pathways are well appreciated for their ability to regulate key events contributing to the cardinal signs of inflammation. Recent evidence indicates that LOX genes are associated with osteoporosis. Also, overexpression of the 15-LOX Type 1 in transgenic rabbits leads to a reduced inflammatory phenotype and protection from periodontal disease, as well as atherosclerosis. Osteoporosis and inflammation-associated bone degradation, such as periodontitis, affect many individuals worldwide and are known to have pathogenesis that involves local mediators via communication between osteoclasts and osteoblasts during osteogenesis. Evidence has emerged indicating that LOX gene expression is associated with reduced bone strength in murine models of osteoporosis. Overexpression of the 15-LOX gene and its products, such as lipoxins, confers endogenous anti-inflammation. This article discusses the recent findings that may link aberrant LOX pathway expression in these diseases, suggesting new avenues for therapeutic approaches via activation of endogenous pathways for resolution of local inflammation.

Shen, E. C., C. H. Gau, et al. (2004). "Periodontal status in post-menopausal osteoporosis: a preliminary clinical study in Taiwanese women." J Chin Med Assoc 67(8): 389-93.

ABSTRACT  BACKGROUND: Osteoporosis and periodontitis are common diseases affecting post-menopausal women; however, the exact relationship between the diseases is still uncertain. The purposes of this study were to examine the periodontal status in a group of type I post-menopausal women with and without osteoporosis and to elucidate the possible role of the osteoporosis in the pathogenesis of periodontal disease. METHODS: Thirty-four patients (18 in the osteoporotic and 16 in the non-osteoporotic group) were selected from 329 post-menopausal Taiwanese women who had completed radiographic measurements of spinal bone mineral density and received full-mouth periodontal examination. Periodontal measurements, including O'Leary plaque index, probing depths, clinical attachment level, and gingival recession, on 6 sites of each tooth of full mouth were examined and recorded by 1 examiner. RESULTS: Significantly greater probing depth was noted at the interproximal, but not at the facio-lingual, osteoporotic sites if compared to those non-osteoporotic sites. The depth was also significantly influenced by the examining factors of plaque accumulation, tooth location, and jaws. By individual jaw, increased attachment loss accompanied by greater probing depth and gingival recession was found at the osteoporotic sites on mandible if compared to non-osteoporotic sites. On maxilla, however, less gingival recession and attachment loss were observed at the osteoporotic sites. CONCLUSIONS: In the present study, increased attachment loss accompanied by greater probing depth and gingival recession was found at the osteoporotic sites on mandible. However, the parameters were also influenced by the examining factors of plaque accumulation, tooth location, and jaws. Therefore, we suggest that post-menopausal osteoporosis may play a role in the pathogenesis of periodontal disease, especially on the mandible, although the etiology of periodontal disease is still multi-factorial.

Takemura, A. and M. Nishida (2006). "[Application of dietary supplement to periodontal disease and osteoporosis]." Clin Calcium 16(2): 354- 58.

ABSTRACT  It is known that there is a relationship between various systemic diseases, life style and periodontal disease. In such a situation, it is becoming clear a relationship between the systemic bone density and the mandibular bone, alveolar bone density and clinical periodontal parameters. And it is also cleared that to lower common risk factors related to these conditions might be useful to prevent osteoporosis and periodontal disease. As it is reported that medical treatment such as hormone replacement therapy (HRT) is effective not only preventing lowering skeletal bone density but also maintaining mandibular and alveolar bones, it is also considered that continuing supplementation of some nutritions such as calcium and isoflavone is also expected to have preventive effects.

von Wowern, N., B. Klausen, et al. (1994). "Osteoporosis: a risk factor in periodontal disease." J Periodontol 65(12): 1134-8.

ABSTRACT  Osteoporosis is suspected as a risk factor in periodontal disease, but previous studies have failed to establish a relationship. Possible explanations for this could be lack of precise methods for assessment of osteoporosis in the jaws and confounding of the result by other factors such as age, gender, or smoking. In the present study 12 female patients with osteoporotic fractures (Group O) and 14 normal women (Group N) were examined clinically for plaque (VPI), gingival bleeding (GBI), and loss of attachment on the 6 Ramfjord index teeth. Bone mineral content (BMC) of the mandible and forearm was determined by dual photon scanning. Results were presented as arithmetic means +/- standard error, and differences between groups were tested by 2-sample t-test. The two groups were comparable with respect to age (O: 68.3 +/- 1.8 years, N: 68.1 +/- 1.5 years), menopausal age (O: 47.5 +/- 1.8 years, N: 47.2 +/- 1.3 years), and smoking habits (O: 4 smokers, N: 3 smokers). The osteoporotic women had significantly lower BMC values than controls in the mandible (O: 0.63 +/- 0.04 in U/cm2; N: 0.78 +/- 0.02 in U/cm2, P < 0.01) and forearm (O: 1.05 +/- 0.05 in U/cm; N: 1.28 +/- 0.05 in U/cm, P < 0.01). No significant differences were found with respect to plaque (O: 46.67 +/- 10.00%, N: 36.67 +/- 6.67%) and gingival bleeding (O: 46.67 +/- 11.67%, N: 43.33 +/- 10.00%), whereas significantly greater loss of attachment was seen in osteoporotic women (O: 3.65 +/- 0.18 mm, N: 2.86 +/- 0.19 mm, P < 0.01).

Wactawski-Wende, J. (2001). "Periodontal diseases and osteoporosis: association and mechanisms." Ann Periodontol 6(1): 197-208.

ABSTRACT  There is increasing evidence that osteoporosis, and the underlying loss of bone mass characteristic of this disease, is associated with periodontal disease and tooth loss. Periodontitis has long been defined as an infection-mediated destruction of the alveolar bone and soft tissue attachment to the tooth, responsible for most tooth loss in adult populations. Current evidence including several prospective studies supports an association of osteoporosis with the onset and progression of periodontal disease in humans. The majority of studies have shown low bone mass to be independently associated with loss of alveolar crestal height and tooth loss. However studies that focus on the relation of clinical attachment loss and osteoporosis are less consistent. To date, the majority of studies on the relationship between periodontal disease and osteoporosis have been hindered by small sample sizes, limited control of other potential confounding factors, varying definitions of both periodontal disease and osteoporosis, and few prospective studies where the temporality of the association can be established. Potential mechanisms by which host factors may influence onset and progression of periodontal disease directly or indirectly include underlying low bone density in the oral cavity, bone loss as an inflammatory response to infection, genetic susceptibility, and shared exposure to risk factors. Systemic loss of bone density in osteoporosis, including that of the oral cavity, may provide a host system that is increasingly susceptible to infectious destruction of periodontal tissue. Studies have provided evidence that hormones, heredity, and other host factors influence periodontal disease incidence and severity. Both periodontal disease and osteoporosis are serious public-health concerns in the United States. Prevalence of both osteoporosis and tooth loss increase with advancing age in both women and men. Understanding the association between these common diseases and the mechanisms underlying those associations will aid health professionals to provide improved means to prevent, diagnose, and treat these very common diseases. This paper reviews the current evidence on the association between periodontal disease and osteoporosis.

Weber, R. L., M. J. Wiesen, et al. (1997). "Osteoporosis: a risk factor for dental implants and in the prognosis of periodontal therapy." Periodontal Clin Investig 19(2): 5-8.

ABSTRACT  Two patients were referred to the Graduate Periodontal Clinic, one for placement of dental implants, the other for treatment of advanced periodontal disease. It was determined from an analysis of the Hounsfield scales of bone density from a CT scan that the patient requesting dental implants had severe osteoporotic changes and was, therefore, not a good candidate for the procedure. The second patient's medical history revealed multiple fractures occurring over the years that suggested the presence of osteoporosis. This diagnosis was subsequently confirmed by referral of the patient to an osteoporosis clinic.

Whalen, J. P. and L. Krook (1996). "Periodontal disease as the early manifestation of osteoporosis." Nutrition 12(1): 53-4.

Yamada, F. (1972). "[Epidemiological studies on the relationship between periodontal diseases and osteoporosis among the farm and fishing villagers in North-East Japan]." Koku Eisei Gakkai Zasshi 22(2): 197-202.

Yoshinari, N., H. Kawase, et al. (2006). "[The relationship between periodontal disease and osteoporosis in animals]." Clin Calcium 16(2): 279-86.

ABSTRACT  Osteoporosis is suspected as a potential risk factor in periodontal disease. However, the detailed relationship between these diseases is unclear. The particular models of laboratory animals for the both diseases are needed to clarify the interactive influence route. In this article, we introduce the animal models for both diseases, review the relationship between osteoporosis and periodontal disease in animals and report our laboratory study. The purpose of our study was to investigate the effect of an ovariectomy on the progression of experimental periodontitis in rats. Thirty female Sprague-Dawley rats as control, 30 sham-operated rats and 30 ovariectomized rats (OVX group) were included. In the maxillary molars of every rat, a nylon thread was ligated to induce experimental periodontitis. The results were as follows : at 6 and 12 weeks in the OVX group, the levels of bone mineral density (BMD) had decreased more significantly. The periodontal tissues in the OVX group showed a severer inflammation and alveolar bone resorption. From these results, it is suggested that the osteoporotic conditions may affect the progression of periodontal lesions in rats. It will be necessary to clarify with a molecular mechanism with the establishment of animal models in both diseases in the future.