Bone Density and Clinical Periodontal Attachment in Postmenopausal Women: A Systematic Review and Meta-Analysis

Abstract

Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and has been considered a risk factor for periodontal disease. The aim of this systematic review and meta-analysis was to verify the scientific evidence for the association of periodontal attachment loss with low BMD in postmenopausal women. A systematic search of the literature was performed in databases until August 2016, in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eligibility criteria included studies that compared clinical attachment loss (CAL) between postmenopausal women with low and normal BMD. Studies using similar methodology, with lower and higher risk of bias, were pooled into 3 different meta-analyses to compare CAL among women with normal BMD, osteoporosis, and osteopenia. In the first meta-analysis, mean CAL was compared among groups. In the other 2 meta-analyses, the mean percentages of sites with CAL ≥4 mm and ≥6 mm were respectively compared among groups. From 792 unique citations, 26 articles were selected for the qualitative synthesis. Eleven of the studies were appraised as presenting low risk of bias, and the association between low BMD and CAL was observed in 10 of these studies. Thirteen cross-sectional articles were included in the meta-analysis for osteoporosis and 9 in the osteopenia analysis. Women with low BMD presented greater mean CAL than those with normal BMD (osteoporosis = 0.34 mm [95% confidence interval (CI), 0.20-0.49], P < 0.001; osteopenia = 0.07 mm [95% CI, 0.01-0.13], P = 0.02). Only studies with lower risk of bias were available for the analysis of CAL severity. Women with low BMD presented more severe attachment loss, represented as mean percentage of sites with CAL ≥4 mm (osteoporosis = 3.04 [95% CI, 1.23-4.85], P = 0.001; osteopenia = 1.74 [95% CI, 0.36-3.12], P = 0.01) and CAL ≥6 mm (osteoporosis = 5.07 [95% CI, 2.74-7.40], P < 0.001). This systematic review and meta-analysis indicates that postmenopausal women with osteoporosis or osteopenia may exhibit greater CAL compared with women with normal BMD.

Significant association between skeletal bone mineral density and moderate to severe periodontitis in fair oral hygiene individuals

“…This study revealed that skeletal BMD in the osteoporosis range was significantly associated with moderate to severe periodontitis in individuals with fair oral hygiene. Our findings also confirmed those of previous studies that demonstrated a significantly lower number of remaining teeth, greater CAL, and greater prevalence and extent of periodontitis as BMD status worsened . In previous studies, a decreased skeletal BMD, as well as a higher prevalence of osteoporosis, were associated with increased tooth loss.…”

Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions

“…There is conflicting evidence regarding the association between osteoporosis and periodontitis. A recent systematic review concluded that postmenopausal women with osteoporosis or osteopenia exhibit a modest but statistically significant greater loss of periodontal attachment compared with women with normal bone mineral density …”

Association between periodontitis and medication‐related osteonecrosis of the jaw: A systematic review and meta‐analysis

“…McGowan et al recently performed a systematic review on this matter identifying 39 different systemic diseases, 14 medical and 11 dental risk factors, thereby elucidating the complexity of this outcome . The close connection between PD and diseases which are commonly managed with ARs, independent of their consumption, and which tend to be either cancers —that particularly favour bone metastasis—, or osteoporosis, has recently been reported in observational studies, building a web of intrigue . On the other hand, the concept of at‐risk patients is hindered by the difficulty in establishing risk factors …”