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O
steoporosis is a rapidly growing
postmenopausal women with a mean age of 62.5 years (SD – health issue related to aging in
6.4 years). These subjects were recruited from patients who industrialized countries where
had received a routine dual-energy x-ray absorptiometry ex- life expectancy for women has risen.1 In
amination in the Radiology Department, King Abdullah Hospi- Jordan, a cross-sectional study2 found
tal, Jordan University of Science and Technology, between that about one-third (29.6%) of women
June 2008 and February 2009. The relationship between skel- with a mean age of 53.23 years had
etal bone mineral density (BMD) and radiographic and clinical osteoporosis as defined by World Health
parameters of periodontal status, including the loss of alveolar Organization (WHO) criteria. In a similar
crestal height (ACH), clinical attachment level, probing depth, female age group in the United States,
and percentage of sites with bleeding on probing, was evaluated 20% of non-Hispanic white and Asian
after controlling for known confounders. women aged ‡50 years had osteoporosis
Results: Bivariate analyses revealed no significant differ- compared to 5% to 10% of non-Hispanic
ences in the severity and extent of clinical attachment and black women; however, it is likely that
ACH loss among women with normal BMD, osteopenia, and os- the disease is underdiagnosed.3 Low
teoporosis. However, in the multivariate analysis, women with systemic bone density and fragility lead
osteoporosis were more likely to have severe ACH loss (odds to fractures that have a significant im-
ratio [OR]: 4.20; 95% confidence interval [CI]: 1.57 to 11.22) pact on physical, psychologic, and so-
and periodontitis (OR: 2.45; 95% CI: 1.38 to 4.34). cial activities that affect the quality of life
Conclusion: Osteoporosis was significantly associated with and are responsible for increased mor-
severe alveolar crestal bone loss and the prevalence of peri- bidity, mortality, and health-care costs.4
odontitis cases in postmenopausal Jordanian women. J Peri- Osteoporosis has been associated with
odontol 2010;81:1613-1621. increased tooth loss in various pop-
ulations.5-8 The relationships among sys-
KEY WORDS
temic bone density, alveolar bone density
Alveolar bone loss; bone density; menopause; osteoporosis; and height,9,10 and clinical attachment
periodontitis. level (CAL) were evaluated.11-15 Women
with low bone mineral density (BMD)
* Preventive Department-Periodontics, College of Dentistry, Jordan University of Science tend to have more attachment loss than
and Technology, Irbid, Jordan.
† Department of Obstetrics and Gynecology, Faculty of Medicine, Jordan University of women with normal BMD;12,13,15 how-
Science and Technology. ever, the relationship between peri-
‡ Departments of Public Health, Community Medicine, and Family Medicine, Jordan
University of Science and Technology. odontal status and osteoporosis varied
§ Department of Oral Surgery, College of Dentistry, Jordan University of Science and depending on the sample size and cor-
Technology.
i Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology. rection for confounding variables.16-19
¶ Department of Periodontics, College of Dentistry, University of Iowa, Iowa City, IA. The evaluation of the relationship be-
tween osteoporosis and periodontitis is
doi: 10.1902/jop.2010.100190
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Association Between Periodontitis and Osteoporosis Volume 81 • Number 11
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J Periodontol • November 2010 Al Habashneh, Alchalabi, Khader, Hazza’a, Odat, Johnson
Table 2.
Periodontal Parameters (mean [SD]) According to Systemic BMD Classification
Gingival recession (mm) 4.34 (1.84) 4.76 (1.72) 4.99 (1.74) 0.871
CAL (mm) 6.40 (2.16) 6.79 (1.98) 6.85 (1.90) 0.671
PD (mm) 2.15 (0.80) 2.17 (0.66) 2.03 (0.53) 0.228
BOP (%) 6.29 (21.82) 10.46 (30.55) 10.88 (30.39) 0.062
Whole-mouth ACH loss (mm) 2.02 (0.48) 2.08 (0.54) 2.17 (0.49) 0.113
Sites with ACH loss ‡2 (%) 65.59 (26.84) 67.14 (28.81) 62.97 (26.57) 0.265
Sites with ACH loss ‡3 (%) 35.09 (21.90) 39.11 (25.82) 33.75 (22.92) 0.077
Sites with ACH loss ‡4 (%) 1.51 (3.78) 1.42 (5.14) 2.05 (4.97) 0.072
Sites with PD ‡3 (%) 36.17 (23.20) 39.38 (26.17) 33.75 (22.92) 0.066
Sites with PD ‡4 (%) 6.92 (17.72) 5.57 (13.02) 6.18 (13.31) 0.292
Sites with PD ‡5 (%) 3.58 (14.27) 2.22 (7.01) 1.56 (4.02) 0.996
Sites with PD ‡6 (%) 2.25 (12.05) 1.33 (4.45) 0.08 (0.61) 0.689
Sites with CAL ‡3 (%) 88.95 (15.74) 89.23 (14.90) 89.73 (16.27) 0.883
Sites with CAL ‡4 (%) 79.66 (21.64) 81.45 (20.44) 80.49 (18.56) 0.488
Sites with CAL ‡5 (%) 68.79 (25.20) 69.96 (26.54) 72.70 (22.76) 0.794
Sites with CAL ‡6 (%) 58.05 (29.56) 64.94 (29.85) 68.37 (24.76) 0.898
PI = plaque index.
Data regarding smoking habits, reproductive history, graphic bone loss, and ‡6 mm clinical attachment loss
medical history, vitamin D supplementation (‡500 IU/ (AL). Clinical examinations were performed by one
day), number of missing teeth, and oral hygiene be- skilled examiner (RA). Before the beginning of the
haviors were also obtained. The body mass index study, the measurement reliability was determined
(BMI) was calculated as weight in kilograms divided on the basis of examinations performed on 10 patients
by height in meters squared. with severe periodontitis. Of the replications, 98%
were within 1 mm for PDs, and 96% were within 1
Periodontal Clinical Examination and mm for CALs. Additional assessments of periodontal
Radiographs status included the plaque index of Silness and Löe,25
The clinical examination included a full-mouth peri- the gingival index (GI) of Löe and Silness,26 and the
odontal assessment. Probing depths (PD) and CALs calculus index (i.e., the presence or absence of calcu-
were measured at six sites (mesial, distal, and middle lus). These parameters were evaluated at four sites
sites of the buccal and lingual sides) on each tooth us- (mesial, distal, buccal, and lingual) on each tooth.
ing a Williams periodontal probe. CAL was measured A series of six intraoral periapical and four vertical
as the distance from the cemento-enamel junction bitewing radiographs was taken of each subject by
(CEJ) to the base of the pocket. The percentage of the radiographer using a standardized long-cone par-
sites with BOP was calculated. Third molars were ex- alleling technique with a film holder.** To standardize
cluded from the examinations. Periodontitis was de- the relationship between the image receptor and
fined using a modification of the criteria of Machtei
et al.24 as ‡2 interproximal sites with ‡5 mm PD, radio- ** Lunar Prodigy Densitometer, New York, NY.
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Association Between Periodontitis and Osteoporosis Volume 81 • Number 11
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J Periodontol • November 2010 Al Habashneh, Alchalabi, Khader, Hazza’a, Odat, Johnson
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Association Between Periodontitis and Osteoporosis Volume 81 • Number 11
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J Periodontol • November 2010 Al Habashneh, Alchalabi, Khader, Hazza’a, Odat, Johnson
33. Shrout MK, Hildebolt CF, Vannier MW. The effect of defects using linear measurements. Eur J Oral Sci
alignment errors on bitewing-based bone loss mea- 2000;108:70-73.
surements. J Clin Periodontol 1991;18:708-712. 38. Tonetti MS, Pini Prato G, Williams RC, Cortellini P.
34. Duckworth JE, Judy PF, Goodson JM, Socransky SS. Periodontal regeneration of human infrabony defects.
A method for the geometric and densitometric stan- III. Diagnostic strategies to detect bone gain. J Peri-
dardization of intraoral radiographs. J Periodontol odontol 1993;64:269-277.
1983;54:435-440. 39. Zybutz M, Rapoport D, Laurell L, Persson GR. Compar-
35. Hausmann E, Christersson L, Dunford R, Wikesjo U, isons of clinical and radiographic measurements of inter-
Phyo J, Genco RJ. Usefulness of subtraction radiog- proximal vertical defects before and 1 year after surgical
raphy in the evaluation of periodontal therapy. J treatments. J Clin Periodontol 2000;27:179-186.
Periodontol 1985;56(Suppl. 11):4-7.
36. Hausmann E, Allen KM, Piedmonte MR. Influence of Correspondence: Dr. Rola Al Habashneh, Preventive De-
variations in projection geometry and lesion size on partment-Periodontics, College of Dentistry, Jordan Uni-
detection of computer-simulated crestal alveolar bone versity of Science and Technology, P.O. Box: 3030, Irbid
lesions by subtraction radiography. J Periodontal Res 22110, Jordan. E-mail: rolaperio@yahoo.com.
1991;26:48-51.
37. Eickholz P, Hausmann E. Accuracy of radiographic Submitted April 3, 2010; accepted for publication May 24,
assessment of interproximal bone loss in intrabony 2010.
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