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Oral Bone Loss May Be Influenced by Infection and Osteoporosis
ETIOLOGY/OTHER
ARTICLE ANALYSIS & EVALUATION ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Osteoporosis and oral infection: independent risk factors for oral bone loss. Brennan-Calanan RM, Genco RJ, Wilding GE, Hovey KM, Trevisan M, WactawskiWende J. J Dent Res 2008;87(4):323-7.
Oral Bone Loss May Be Influenced by Infection and Osteoporosis SUMMARY Subjects Subjects included 1256 postmenopausal women with at least 6 teeth present and no signs of other bone disease.
Key Risk/Study Factor REVIEWER Pouran Famili, DMD, MDS, MPH, PhD
Osteoporosis and oral infection in postmenopausal women.
Main Outcome Measure Evaluation of the association of osteoporosis, oral bacteria, and alveolar crest height.
PURPOSE/QUESTION To evaluate the association between osteoporosis and oral bone loss, assessing whether oral bacteria and age modify those associations.
SOURCE OF FUNDING Government funded with grants from NIDCR (Bethesda, MD) and USARMC
TYPE OF STUDY/DESIGN Cross-sectional study
Main Results The authors evaluated associations between bone density and alveolar crestal height and clinical oral bone loss after adjustment for age, smoking status, hormone therapy, and calcium and vitamin D supplementation. Infection by Tannerella forsythensis was not a cofounder of the association between systemic bone density and alveolar crestal height. Postmenopausal women had worse oral bone loss in general, but neither bone density nor oral infection was significantly associated with mean alveolar bone height.
Conclusions The authors found a significant interaction between systemic bone density and age and concluded that systemic bone density and oral infection independently influenced oral bone loss in postmenopausal women younger than 70 years.
LEVEL OF EVIDENCE
COMMENTARY AND ANALYSIS
Level 3: Other Evidence
Osteoporosis and periodontal disease may have common risk factors,1 yet prior studies have reported inconsistent findings regarding low bone density and alveolar bone height. The purpose of this cross-sectional study was to evaluate the association between osteoporosis and oral bone loss, assessing whether oral bacteria and age modify those associations. The study was conducted at the University of Buffalo center of the Women’s Health Initiative’s Observational Study. Systemic bone density was measured by dual-energy x-ray absorptiometry. Determination of osteoporosis and osteopenia was not clearly described in the methods. Alveolar crestal height was measured from standardized dental radiographs. Oral infection was assessed from subgingival plaque samples (T. forsythensis). The authors concluded that systemic bone density and oral infection independently influenced oral bone loss in postmenopausal women younger than 70 years. Because the first few years up to a decade following menopause is associated with a significant lowering of natural estrogen production and subsequent bone loss, it should not be unexpected to see
STRENGTH OF RECOMMENDATION GRADE Not applicable
J Evid Base Dent Pract 2009;9:99-100 1532-3382/$34.00 Ó 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.jebdp.2009.03.009
JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE
postmenopausal women younger than 70 showing an association between systemic bone density and alveolar bone loss. Using multivariate linear regression to adjust for socioeconomic indicators, smoking, hormone replacement therapy, calcium supplementation, and other factors, the authors found that total forearm bone density and T. forsythensis infection was significantly associated with mean alveolar bone height for postmenopausal women younger than 70; however, systemic bone density (total body) was not associated with mean alveolar bone loss for these women. For women aged 70 years and older, infection with T. forsythensis or bone density was not associated with mean alveolar bone height. Using a different analytical approach (multivariate logistic regression) and adjusting for the same factors as previously mentioned, the authors found that women 70 years and older with osteoporosis were up to 3 times as likely to have alveolar bone loss compared with similarly aged nonosteoporotic women. There was no association between osteoporosis and alveolar bone loss in women younger than 70 years. T. forsythensis infection was not associated with alveolar bone loss in either age group in the adjusted logistic regression models. The authors found a strong interaction between systemic bone density and age and presented a stratified
100
analysis to control for this interaction. Given that the reported aim of the study was to explore the relationship between osteoporosis and oral bone loss with the potential for oral bacteria to modify that relationship, the authors did find a significant association between osteoporosis and alveolar bone loss independent of T. forsythensis infection only in women aged 70 years and older. No other cross-sectional studies have been published that assessed the association between forearm and whole-body bone density and alveolar bone crest. Findings from crosssectional studies are very useful for exploring hypotheses; however, longitudinal studies are necessary to determine the temporality of these associations.
REFERENCES 1. Wactawski-Wende J. Periodontal diseases and osteoporosis: association and mechanisms. Ann Periodontol 2001;6:197-208.
REVIEWER Pouran Famili, DMD, MDS, MPH, PhD Professor and Chair, Periodontics/Preventive Dentistry, B94 Salk Hall, 3501 Terrace Street, Pittsburgh, PA 15261 [email protected]
June 2009
ARTICLE ANALYSIS & EVALUATION ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Osteoporosis and oral infection: independent risk factors for oral bone loss. Brennan-Calanan RM, Genco RJ, Wilding GE, Hovey KM, Trevisan M, WactawskiWende J. J Dent Res 2008;87(4):323-7.
Oral Bone Loss May Be Influenced by Infection and Osteoporosis SUMMARY Subjects Subjects included 1256 postmenopausal women with at least 6 teeth present and no signs of other bone disease.
Key Risk/Study Factor REVIEWER Pouran Famili, DMD, MDS, MPH, PhD
Osteoporosis and oral infection in postmenopausal women.
Main Outcome Measure Evaluation of the association of osteoporosis, oral bacteria, and alveolar crest height.
PURPOSE/QUESTION To evaluate the association between osteoporosis and oral bone loss, assessing whether oral bacteria and age modify those associations.
SOURCE OF FUNDING Government funded with grants from NIDCR (Bethesda, MD) and USARMC
TYPE OF STUDY/DESIGN Cross-sectional study
Main Results The authors evaluated associations between bone density and alveolar crestal height and clinical oral bone loss after adjustment for age, smoking status, hormone therapy, and calcium and vitamin D supplementation. Infection by Tannerella forsythensis was not a cofounder of the association between systemic bone density and alveolar crestal height. Postmenopausal women had worse oral bone loss in general, but neither bone density nor oral infection was significantly associated with mean alveolar bone height.
Conclusions The authors found a significant interaction between systemic bone density and age and concluded that systemic bone density and oral infection independently influenced oral bone loss in postmenopausal women younger than 70 years.
LEVEL OF EVIDENCE
COMMENTARY AND ANALYSIS
Level 3: Other Evidence
Osteoporosis and periodontal disease may have common risk factors,1 yet prior studies have reported inconsistent findings regarding low bone density and alveolar bone height. The purpose of this cross-sectional study was to evaluate the association between osteoporosis and oral bone loss, assessing whether oral bacteria and age modify those associations. The study was conducted at the University of Buffalo center of the Women’s Health Initiative’s Observational Study. Systemic bone density was measured by dual-energy x-ray absorptiometry. Determination of osteoporosis and osteopenia was not clearly described in the methods. Alveolar crestal height was measured from standardized dental radiographs. Oral infection was assessed from subgingival plaque samples (T. forsythensis). The authors concluded that systemic bone density and oral infection independently influenced oral bone loss in postmenopausal women younger than 70 years. Because the first few years up to a decade following menopause is associated with a significant lowering of natural estrogen production and subsequent bone loss, it should not be unexpected to see
STRENGTH OF RECOMMENDATION GRADE Not applicable
J Evid Base Dent Pract 2009;9:99-100 1532-3382/$34.00 Ó 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.jebdp.2009.03.009
JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE
postmenopausal women younger than 70 showing an association between systemic bone density and alveolar bone loss. Using multivariate linear regression to adjust for socioeconomic indicators, smoking, hormone replacement therapy, calcium supplementation, and other factors, the authors found that total forearm bone density and T. forsythensis infection was significantly associated with mean alveolar bone height for postmenopausal women younger than 70; however, systemic bone density (total body) was not associated with mean alveolar bone loss for these women. For women aged 70 years and older, infection with T. forsythensis or bone density was not associated with mean alveolar bone height. Using a different analytical approach (multivariate logistic regression) and adjusting for the same factors as previously mentioned, the authors found that women 70 years and older with osteoporosis were up to 3 times as likely to have alveolar bone loss compared with similarly aged nonosteoporotic women. There was no association between osteoporosis and alveolar bone loss in women younger than 70 years. T. forsythensis infection was not associated with alveolar bone loss in either age group in the adjusted logistic regression models. The authors found a strong interaction between systemic bone density and age and presented a stratified
100
analysis to control for this interaction. Given that the reported aim of the study was to explore the relationship between osteoporosis and oral bone loss with the potential for oral bacteria to modify that relationship, the authors did find a significant association between osteoporosis and alveolar bone loss independent of T. forsythensis infection only in women aged 70 years and older. No other cross-sectional studies have been published that assessed the association between forearm and whole-body bone density and alveolar bone crest. Findings from crosssectional studies are very useful for exploring hypotheses; however, longitudinal studies are necessary to determine the temporality of these associations.
REFERENCES 1. Wactawski-Wende J. Periodontal diseases and osteoporosis: association and mechanisms. Ann Periodontol 2001;6:197-208.
REVIEWER Pouran Famili, DMD, MDS, MPH, PhD Professor and Chair, Periodontics/Preventive Dentistry, B94 Salk Hall, 3501 Terrace Street, Pittsburgh, PA 15261 [email protected]
June 2009