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The magnitude of an association between periodontal attachment loss and osteoporosis or osteopenia is small
JADA+ CONTENT
This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always, any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable consequences outweigh all potentially undesirable consequences.
JADA+ CLINICAL SCANS
Romina Brignardello-Petersen, DDS, MSc, PhD
THE MAGNITUDE OF AN ASSOCIATION BETWEEN PERIODONTAL ATTACHMENT LOSS AND OSTEOPOROSIS OR OSTEOPENIA IS SMALL
Penoni DC, Fidalgo TK, Torres SR, et al. Bone density and clinical periodontal attachment in postmenopausal women. J Dent Res. 2017;96(3): 261-269. http://dx.doi.org/10.1177/0022034516682017. Key words. Periodontics; bone mineral density; clinical attachment level; osteoporosis; osteopenia; periodontal disease; systematic review. Clinical relevance. Although it might be beneficial to refer patients to a specialist for prevention and treatment of osteoporosis and osteopenia, the evidence provided by researchers addressing the association between these conditions and periodontal disease is diverse and has not provided definite answers. Study summary. The authors conducted this systematic review (SR) to determine whether there was an association between periodontal attachment loss and bone mineral density in postmenopausal women (PW). The authors searched for observational comparative studies in 5 electronic databases and the gray literature. They included 20 cross-sectional and 6 longitudinal studies. These studies included 42 to 5,922 PW. PW with osteoporosis had an average of 0.34 millimeters more clinical attachment loss,* 3.04% more sites with clinical attachment loss of 4 or more mm,y and 5.07% more sites with clinical attachment loss of 6
or more mm.z PW with osteopenia had an average of 0.07 mm more clinical attachment loss§ and an average of 1.74% more sites with clinical attachment loss of 4 or more mm.{ Strengths and limitations. This SR is of high methodological quality. The authors followed high standards when designing and conducting this SR, and we are confident that the reviewers included all the relevant evidence. Although the authors found that more than onehalf of the included studies had high risk of bias, when the authors compared the results of studies with high risk of bias and those with low risk of bias, the results did not differ, which strengthened our certainty in the results. The results were consistent across studies, and the pooled estimates of association were precise. Although publication bias was not explicitly addressed by the authors, we do not suspect that it had occurred. Accordingly, this SR provides high-quality evidence of an association between periodontal attachment loss and osteoporosis or osteopenia. When using these results in clinical practice, clinicians should keep in mind that this association does not represent causation. More importantly, although it is statistically significant, the magnitude of the association is small and unlikely to be of clinical importance. n http://dx.doi.org/10.1016/j.adaj.2017.02.025 Copyright ª 2017 American Dental Association. All rights reserved.
Address correspondence to Dr. Brignardello-Petersen at e-mail [email protected]. Disclosure. Dr. Brignardello-Petersen did not report any disclosures. * 95% confidence interval (CI) of the mean difference, 0.20 to 0.49; 13 studies, 1,787 participants. y 95% CI of the mean difference, 1.23 to 4.85; 4 studies, 1,252 participants. z 95% CI of the mean difference, 2.74 to 7.40; 2 studies, 364 participants. § 95% CI of the mean difference, 0.01 to 0.13; 9 studies, 2,023 participants. { 95% CI of the mean difference, 0.36 to 3.12; 3 studies, 1,667 participants.
JADA 148(4) http://jada.ada.org
April 2017 e41
This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always, any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable consequences outweigh all potentially undesirable consequences.
JADA+ CLINICAL SCANS
Romina Brignardello-Petersen, DDS, MSc, PhD
THE MAGNITUDE OF AN ASSOCIATION BETWEEN PERIODONTAL ATTACHMENT LOSS AND OSTEOPOROSIS OR OSTEOPENIA IS SMALL
Penoni DC, Fidalgo TK, Torres SR, et al. Bone density and clinical periodontal attachment in postmenopausal women. J Dent Res. 2017;96(3): 261-269. http://dx.doi.org/10.1177/0022034516682017. Key words. Periodontics; bone mineral density; clinical attachment level; osteoporosis; osteopenia; periodontal disease; systematic review. Clinical relevance. Although it might be beneficial to refer patients to a specialist for prevention and treatment of osteoporosis and osteopenia, the evidence provided by researchers addressing the association between these conditions and periodontal disease is diverse and has not provided definite answers. Study summary. The authors conducted this systematic review (SR) to determine whether there was an association between periodontal attachment loss and bone mineral density in postmenopausal women (PW). The authors searched for observational comparative studies in 5 electronic databases and the gray literature. They included 20 cross-sectional and 6 longitudinal studies. These studies included 42 to 5,922 PW. PW with osteoporosis had an average of 0.34 millimeters more clinical attachment loss,* 3.04% more sites with clinical attachment loss of 4 or more mm,y and 5.07% more sites with clinical attachment loss of 6
or more mm.z PW with osteopenia had an average of 0.07 mm more clinical attachment loss§ and an average of 1.74% more sites with clinical attachment loss of 4 or more mm.{ Strengths and limitations. This SR is of high methodological quality. The authors followed high standards when designing and conducting this SR, and we are confident that the reviewers included all the relevant evidence. Although the authors found that more than onehalf of the included studies had high risk of bias, when the authors compared the results of studies with high risk of bias and those with low risk of bias, the results did not differ, which strengthened our certainty in the results. The results were consistent across studies, and the pooled estimates of association were precise. Although publication bias was not explicitly addressed by the authors, we do not suspect that it had occurred. Accordingly, this SR provides high-quality evidence of an association between periodontal attachment loss and osteoporosis or osteopenia. When using these results in clinical practice, clinicians should keep in mind that this association does not represent causation. More importantly, although it is statistically significant, the magnitude of the association is small and unlikely to be of clinical importance. n http://dx.doi.org/10.1016/j.adaj.2017.02.025 Copyright ª 2017 American Dental Association. All rights reserved.
Address correspondence to Dr. Brignardello-Petersen at e-mail [email protected]. Disclosure. Dr. Brignardello-Petersen did not report any disclosures. * 95% confidence interval (CI) of the mean difference, 0.20 to 0.49; 13 studies, 1,787 participants. y 95% CI of the mean difference, 1.23 to 4.85; 4 studies, 1,252 participants. z 95% CI of the mean difference, 2.74 to 7.40; 2 studies, 364 participants. § 95% CI of the mean difference, 0.01 to 0.13; 9 studies, 2,023 participants. { 95% CI of the mean difference, 0.36 to 3.12; 3 studies, 1,667 participants.
JADA 148(4) http://jada.ada.org
April 2017 e41