J Clin Periodontol 2002: 29: 796–802 Copyright C Blackwell Munksgaard 2002

Printed in Denmark . All rights reserved

0303-6979

Assessment of periodontal R. E. Persson, L. G. Hollender,

L. V. Powell, M. I. MacEntee,
C. C. L. Wyatt, H. A. Kiyak and

conditions and systemic disease G. R. Persson

1
Department of Oral Medicine, 2Department
of Oral Maxillofacial Surgery and the Institute

in older subjects on Aging, and 3Department of Periodontics,

University of Washington, Seattle, WA,
4
Private practice, Ukia, CA, USA, 5Division of
Prosthodontics, University of British Columbia.
I. Focus on osteoporosis Vancouver B.C., Canada

Persson RE, Hollender LG, Powell LV, MacEntee MI, Wyatt CCL, Kiyak HA,
Persson GR: Assessment of periodontal conditions and systemic disease in older
subjects. I. Focus on osteoporosis. J Clin Periodontol 2002; 29: 796–802.
CBlackwell Munksgaard, 2002.

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 associ-
ated 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 find-
ings 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 sub-
jects 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 epide-
miological studies, but only partly consistent with a self-reported history of osteo-
porosis with a higher prevalence of positive MCI in Chinese women. Horizontal Key words: ethnicity; older; osteoporosis;
alveolar bone loss is associated with both positive self-reported OPOR and panoramic radiograph; periodontitis
MCI. Accepted for publication 27 August 2001

Although the average lifespan in most
western societies is increasing, both sys-
temic and oral health deteriorate with
aging. Concurrently, the leading cause
of death has shifted from infectious to
chronic diseases. In the early 20th cen-
tury, infectious respiratory diseases ac-
counted for nearly a quarter of all
deaths, whereas recently the leading
causes of death in adults 45 and older
in the United States were heart disease,
cancer, stroke, chronic obstructive pul-
monary disease, accidents (uninten-
tional injuries), pneumonia, influenza,
diabetes, suicide, kidney, and chronic
liver disease (Guyer et al. 2000).
Osteoporosis is a degenerative disease
that affects approximately 20 million
people in the United States and causes
approximately 2 million fractures each
year (National Institute of Arthritis and

Skin diseases 2000). Studies have shown
that mandibular bone mass is corre-
lated with skeletal bone mass (Kribbs
et al. 1983; 1984; Von Wowern et al.
1994). Postmenopausal women who do
not use hormone replacement therapy
exhibit a strong negative correlation be-
tween the number of teeth retained and
the time since menopause (Becker et al.
1997). Older women taking hormone
replacement therapy appear to have
better periodontal health than women
not on therapy (Persson et al. 1998,
Payne et al. 1999).
Several factors have been associated
with osteoporosis, including female
gender, age, ethnicity, diet, and smok-
ing. Routine medical methods to diag-
nose subjects with osteopenia, an early
stage of osteoporosis, and osteoporosis
include single photon absorptiometry,
dual energy X-ray absorption , and
quantitative computed tomography.
PMS methods to study bone density
and anatomy associated with osteporot-
ic changes have been published
(Southard et al. 1992, Klemetti et al.
1993, 1994a, Taguchi et al. 1995a, Boll-
en et al. 2000).
Studies have also found that spinal
fractures in older women are associated
with fewer remaining teeth and peri-
odontitis, suggesting that periodontitis
may be aggravated in subjects with os-
teoporosis (Taguchi et al. 1995a,1995b,
Birkenfeld et al. 1999). Other cross-sec-
tional studies suggest an association be-
tween systemic osteoporosis and peri-
odontal status in postmenopausal non-
Hispanic white women (Mohammad
et al. 1996, Wactawski-Wende et al.
1996). Subjects with a self-reported his-
Table 1. Subject demographic characteristics
Seattle
Variable n Ω 701
Gender
Male 40.5 %
Female 59.5 %
Ethnicity
Caucasian 48.0 % 46.7
Chinese 35.8 % 18.2
East Indian 0.0 % 29.9
African American 10.7 % 1.6
Other 5.5 % 3.6
Smoking status
Current smoker 7.9 %
Quit smoker 31.2 %
Never smoker 60.9 %
Age (mean ∫ SD) 67.1 ∫ 4.7
Remaining teeth 21.7 ∫ 6.8
(mean ∫ SD)
Panoramic radiography, periodontitis and osteoporosis
tory of osteoporotic fractures also tend
to have increased resorption and thin-
ning of the mandibular lower cortex
(Bollen et al. 2000). However, other
studies have failed to demonstrate as-
sociations between periodontal status
and the early stage of osteopenia, and
osteporosis (Mohajery & Brooks 1992,
Hildebolt et al. 1997).
The 1992 US National Institute of
Health Workshop on osteoporosis and
oral bone loss recommended popula-
tion-based studies of the association be-
tween osteoporosis and oral conditions
(McGowan & Redford 1993). Thus,
larger cross-sectional and longitudinal
studies are needed. The objectives of the
present study were:
O to study the prevalence of osteo-
penia/osteoporosis as defined by self-
report in an older, ethnically diverse
population;
O to determine to what extent such
findings agreed with panoramic
radiographic findings of cortical
bone changes suggesting osteopor-
osis;
O to test whether panoramic signs or
self-reported history of osteoporosis
are associated with a diagnosis of
periodontitis.
Material and methods
The present study was approved by the
institutional Review Boards (IRBs) at
the University of Washington and the
University of British Columbia. A total
of 1101 subjects from the Seattle and
Vancouver metropolitan areas (pre-
Vancouver Combined
n Ω 383 n Ω 1084
57.0 % 46.3 %
43.0 % 53.7 %
% 47.6 % maining teeth along with the number of
% 29.7 %
% 10.4 %
% 7.6 %
% 4.7 % counted. The extent of alveolar (hori-
4.8 % 7.5 %
34.3 % 32.0 %
59.2 % 60.5 %
67.0 ∫ 4.9 67.1 ∫ 4.7
22.4 ∫ 6.3 22.0 ∫ 6.6
797
dominantly European descendants,
Chinese, African-American, and His-
panic in Seattle; European descendants,
Chinese and East Indians in Vancouver)
between the ages of 60 and 75 years with
at least four natural teeth were recruited
(Kiyak et al. 2000). Efforts were made
to enroll a regionally representative eth-
nic distribution of subjects. Each sub-
ject was asked to complete a compre-
hensive health questionnaire and to
provide a list of medications and their
dosages. In the event a subject could
not provide such lists, contacts were
made with their physicians to collect the
information. Medication data were ob-
tained directly from the containers
brought in by participants. For the non-
English-speaking subjects, the health
questionnaire was translated using a
double translation process. All inter-
views with non-English speaking sub-
jects were conducted in their native lan-
guages by a translator who was a native
speaker of each language.
At the University of Washington the
PMXs were taken at the Division of
Oral Radiology, Department of Oral
Medicine, using an Orthophos Plus
(Siemens AG, Bensheim, Germany),
whereas the PMXs in Vancouver were
taken at community dental practices or
the Dental School at the University of
British Columbia using different equip-
ment (i.e. Planmeca, Panalipse, Or-
thophos, Helsinki, Finland). Two exam-
iners (L.G.H. and R.E.P.) jointly ana-
lyzed and reached consensus agreement
on all PMX films. The mandibular cor-
tex index (MCI) was assigned as appro-
priate for the cortical area below the
mandibular foramen. (Klemetti et al.
1994b, Jowitt et al. 1999). Briefly, the
mandibular cortex on a panoramic
radiograph was classified as ‘0’ or nor-
mal (even and sharp endosteal margin),
‘1’ moderately eroded (evidence of la-
cunar resorption or endosteal cortical
residues), or ‘2’ severely eroded (un-
equivocal porosity).
The frequencies of mesial and distal
vertical bone defects ⱖ3 mm around re-
molars showing an identifiable interrad-
icular marginal radiolucency were
zontal) bone height was assessed using
a composite periodontal index (0–3),
where a score of ‘0’ was assigned when
there was no sign of horizontal bone
loss or interradicular radiolucency; a
score of ‘1’ if the extent of overall bone
loss was less than 25%, a score of ‘2’ if
798 Persson et al.

the extent of bone loss varied between Table 2. Self-reported osteoporosis, osteoarthritis, chronic pain, and MCI scores
25 and 50%, and a score of ‘3’ if the Variable Seattle Vancouver Combined
overall extent of bone loss exceeded
Self-report
50% of the root length. To assess the Osteoporosis 7.9 % 8.8 % 8.2 %
odds ratio of association between a self- Osteoarthritis 38.7 % 28.3 % 35.0 %
reported history of osteopenia/ostep- Chronic pain 17.7 % 8.8 % 14.6 %
orosis and periodontitis, only subjects Self-report osteoporosis by ethnicity
who scored ‘0’ on the radiographic as- Caucasian 7.8 % 7.6 % 7.8%
sessment were identified as peri- Chinese 9.2 % 20.9 % 11.7 %
odontally normal. All others were iden- African American 4.0 % 3.7 % 3.9 %
tified as subjects with periodontitis East Indian
MCI
(composite PMX index).
All subjects 40.8 % 34.2 % 38.9 %
Females 51.9 % 54.0 % 49.1 %
Data analysis

Descriptive statistics were used to pres-

ent information about the prevalence of
systemic diseases and PMX findings.
The Mantel–Haenszel (common odds
ratio) estimate was used to measure
agreements between the periodontal di-
agnosis and self-reported osteoporosis
status.  (both independent para-
metric and nonparametric tests) was
used to assess differences by ethnicity
and gender. Correlation coefficients
were defined by Spearman rank corre-
lation. Data were analyzed with the
SPSS statistical package 10.0 (Chicago,
IL, USA).
Results
Sample characteristics (Table 1)
Sample characteristics were, in general,
similar between Seattle and Vancouver
and consistent with area characteristics.
Proportionally more women were en-
rolled at the Seattle study site (c2 Ω
35.7, P ⬍ 0.0001). No statistically sig-
nificant differences between the Seattle
and Vancouver cohorts were found for
the following variables: age, number of
remaining teeth, or smoking status.
Panoramic radiographs were available
for analysis from 1084 of the originally
1101 enrolled subjects.
teoporosis were found by ethnicity (P ⬍
0.02, n-par Kruskal–Wallis ).
Thus, the Chinese participants more fre-
quently reported a history of osteopor-
osis than did the Caucasians (P ⬍ 0.05)
or African Americans (P ⬍ 0.03). Al-
though not clinically relevant, subjects
who reported a history of osteoporosis
had significantly fewer teeth than those
who did not report this condition (mean
values 20.2 versus 22.1 respectively, t Ω
1.4, P ⬍ 0.01). In women the correlation
between the use of hormonal replace-
ment therapy and a self-reported history
of osteoporosis was significant (rΩ0.16,
P ⬍ 0.01). HRT was prescribed to 68% of
Caucasian women, 22.1% of African
American women, but none of the Chi-
nese women were using HRT.
Seattle subjects reported a higher fre-
quency of chronic pain than did their
counterparts in Vancouver (c2 Ω 40.6, P
⬍ 0.0001). Significant correlations
emerged between a self-reported history
of osteoporosis and osteoarthritis (r Ω
0.36, P ⬍ 0.001, Spearman rank corre-
lation test) and between osteporosis and
chronic pain (r Ω 0.20, P ⬍ 0.001, Spear-
man rank correlation test). The com-
mon odds ratio (Mantel–Haentzel) for
an agreement between self-reported os-
teoporosis and osteoarthritis was 4.2
(95%CI 2.2, 6.8, P ⬍ 0.001), and be-
tween osteoporosis and chronic pain 3.2
(95%CI: 2.0, 5.3, P ⬍ 0.001).
PMX findings
The PMX films allowed assessment of
the mandibular cortex in 90.3% of the
films (99.6% for Seattle, and 74.3% for
Vancouver). The intraclass correlation
between MCI and self-reported diag-
nosis of osteoporosis was only 0.20

Self-reported osteoporosis, osteoarthritis

and chronic pain (Table 2)

Osteoporosis was reported by 8.2 % of

the subjects. Significantly more women
reported a history of osteoporosis
(women 13.1 %, men 2.2% (c2 Ω 40.2, P
⬍ 0.0001) and consistent with general
perceptions of disease distribution by
gender. No differences in the reported
history of osteoporosis were found be-
tween Seattle and Vancouver subjects.
Overall significant differences in the dis- Fig. 1. ROC curve demonstrating the MCI test characteristics using self-reported history of
tribution of self-reported history of os- osteoporosis as the gold standard.
 Panoramic radiography, periodontitis and osteoporosis 799

(95%CI: 0.10, 0.30), but it was statisti-
cally significant (P ⬍ 0.01). PMX find-
ings by MCI suggesting osteoporosis
were found in 38.9% of the subjects
(MCI score ⱖ1). If the MCI cutoff was
set at a score ⱖ2, only 11.0% of the
subjects would have had a positive MCI
score. Using the MCI cutoff point ⱖ1
the sensitivity of the MCI score to
identify self-reported osteoporosis was
0.61, with a specificity of 0.67. Al-
though the predictive value positive was
low (12.7%) the predictive value nega-
tive was high (94.6%). The common
odds of an association between the
MCI 0/ⱖ 1 score and self-reported his-
tory of osteoporosis (0/1) was 2.6
(95%CI: 1.6, 4.1, P ⬍ 0.001). The ROC
(receiver operator characteristic curve)
illustrates the performance of the MCI
to identify subjects with or without a
self-reported history of osteoporosis
(Fig. 1).
Periodontal characteristics are pre-
sented in Table 3. Approximately half
(48.5%) of the subjects had evidence of
alveolar bone loss. Periodontal findings
among the four major ethnic groups are
presented in Table 2. Analysis by 
(Post-Hoc Bonferroni test) demon-
strated significant ethnic differences,
such that the Chinese population had
significantly more teeth with vertical de-
fects than the Caucasians (F Ω 3.0, P ⬍
0.02). Neither ethnic nor gender differ-
ences, however, were found for overall
horizontal bone loss or furcation in-
vasions. The composite PMX peri-
odontal score also demonstrated that
the Chinese subjects had a significantly
higher prevalence of periodontitis than
the Caucasians (P ⬍ 0.001 Mann–Whit-
ney U-test).
When the data were specifically ana-
lyzed for women only, the association
between self-reported osteoporosis and
radiographic evidence of periodontitis
(composite PMX index) was significant,
with a common odds ratio of 1.8
(95%CI: 1.2, 2.5, P ⬍ 0.001). These find-
ings were confirmed by non-parametric
analysis using the Mann–Whitney U-
test, demonstrating that the distribution
of horizontal alveolar bone loss as de-
fined by the composite periodontal
PMX index was significantly higher in
subjects with a positive MCI (cutoff ⱖ1)
(P ⬍ 0.01). No differences in prevalence
or vertical alveolar bone defects were
found. The distribution of horizontal
bone loss scores (composite by MCI and
self-reported osteoporosis are presented
in Fig. 2 (A and B). Women using HRT
had significantly fewer PMX signs of
horizontal alveolar bone loss (P ⬍ 0.05,
Mann–Whitney U-test). Thus, the data
support the hypothesis that self-reported
osteoporosis and assessments of cortical
bone changes from PMX and the pres-
ence and severity of periodontitis as de-
fined by a composite alveolar bone index
are associated.
Discussion
The reproducibility of bone mineral
density measurements by dual energy
X-ray absorptiometry commonly used
to determine whether a subject has os-
teporosis or not has limitations (Philli-
pov & Phillips 2001). Therefore, a diag-
nosis of osteoporosis and especially its
earlier stages may be difficult. As a re-
sult, many older people may have osteo-
porosis without knowing it. Older
adults often present with significant
horizontal alveolar bone loss, and may
therefore benefit from also being screen-
ed for osteoporosis. Medication to pre-
vent or limit the effects of osteoporosis
with drugs containing biphosphonate
affects prostaglandin E2 production,
and may also help reduce progressive
alveolar bone loss.
PGE2 upregulates osteoclast activity,
especially, in cases of estrogen de-
ficiency (Kanematsu et al. 2000).
Osteoporosis is influenced by the
socioeconomic status of older women
(Varenna et al. 1999). Self-reports from
subjects in a Swedish study, based on
diagnostic criteria from the NHANES
III in the USA, reveal that the preva-
lence of osteoporosis approaches 22%
in women and 6.3% in men between

Table 3. Percent distribution of vertical defects, horizontal bone loss scores, furcation defects, and composite PMX periodontal index based
on assessments from panoramic radiographs and the three largest ethnic groups at the Seattle and Vancouver study sites with the all subject
category representing all nine ethnic groups studied
Seattle study site

Vertical defects Horizontal bone loss Furcation Composite PMX

(%) score (%) defects (%) Periodontal Index

0 1–3 ⱖ4 0 1 2 3 0 1π 0 1
Ethnicity
Caucasian 74.7 22.4 2.9 52.4 32.7 8.9 5.1 77.3 22.7 52.7 47.3
Chinese 57.6 38.6 3.8 44.2 40.0 12.0 5.6 52.0 48.0 42.6 57.4
African American 58.4 37.7 3.9 49.4 35.1 11.7 3.9 79.2 20.8 49.4 50.6
All subjects 67.8 29.5 2.7 48.8 35.5 10.4 4.8 68.6 31.4 49.0 51.0
Vancouver study site

Vertical defects Horizontal bone loss Furcation Composite PMX

(%) score (%) defects (%) Periodontal Index

0 1–3 ⱖ4 0 1 2 3 0 1π 0 1
Ethnicity
Caucasian 66.7 21.7 1.6 64.9 26.0 7.6 1.5 74.0 26.0 64.9 35.1
Chinese 65.3 28.6 6.1 38.0 50.0 10.0 2.0 60.7 29.3 38.0 62.0
East Indian 62.2 33.4 4.4 60.7 31.5 6.7 1.1 63.3 36.7 60.7 39.3
All subjects 67.6 32.6 3.8 56.8 32.1 7.8 2.4 66.0 34.0 57.7 42.3
800 Persson et al.
Fig. 2. Distribution of composite periodontal index scores (A) by positive or negative MCI
status and (B) by positive or negative self-reported osteoporosis status.
the ages of 50 and 84 years (Kanis
et al. 2000). Our panoramic evaluation
of the mandibular cortex identified os-
teporosis/osteopenia in 52.4% of the
women, or approximately 2.5 times the
prevalence rate reported by Kanis
et al. (2000), and four times the rate
obtained from the self-reports of our
subjects. Studies using dual X-ray ab-
sorptiometry suggest that osteoporosis
can be diagnosed in 49–72% of women
at the age of 70 (Löfman et al. 2000).
Assessment of mandibular cortical
bone changes (MCI) might be more
accurate than self-reports from the el-
dery who have the disorder but have
not been diagnosed. A majority of the
subjects in the present study came
from low-income backgrounds and
may not have had access to medical di-
agnosis and care/prevention of osteo-
porosis. The fact that especially Chi-
nese women in the present study ex-
pressed signs of osteoporosis and did
not use HRT suggests that they had
not been examined and would not
have known if they had osteoporosis
or not.
Good dental practice requires that
the dentist collects and reviews a pa-
tient’s medical history, most commonly
self-reported by the patient. Ideally, a
professional medical history should be
obtained for all dental and research
patients. In the present study, infor-
mation about medications was col-
lected and confirmed as necessary by
the prescribing physician. This pro-
cedure provided a mechanism by
which the investigators could confirm
the self-reported history given by sub-
jects. Patients seeking dental care may
or may not be particularly aware of
their general health (Thompson et al.
1999). Approximately 75% of a self-re-
ported history of a myocardial infarct
or a stroke is accurate (Psaty et al.
1995). Nevertheless, others have dem-
onstrated that a self-administered
questionnaire can assess accurately the
prevalence of stroke in epidemiological
research (Engstad et al. 2000).
In the present study a relatively high
proportion of Caucasian women used
HRT, which is the most commonly
prescribed drug to prevent osteopor-
osis. In the present study, a large pro-
portion of Caucasian women with a
self-report or PMX evidence of osteo-
porosis used HRT. However, no Chi-
nese subjects used HRT despite a
higher prevalence of osteoporosis in
this group. This seems to be consistent
with the present finding of a higher
prevalence of both self-reported and
PMX identified signs of osteoporosis
in Chinese women. The fact that
chronic pain was reported more fre-
quently among women is suggestive of
osteoporosis, as chronic pain often is
present in subjects with osteoporosis
(Malmros et al. 1998). In previous
studies, HRT has been associated with
better periodontal status and a de-
creased risk for tooth loss (Persson
et al. 1998). Therefore the use of HRT
may have confounded the present re-
sults. However, the only two factors
statistically identified as associated
with osteoporosis were gender and eth-
nicity.
In conclusion, the present study de-
monstrated that the prevalence of signs
of osteoporosis from PMX using the
MCI as described by Klemetti et al.
(1994a) is high and consistent with epi-
demiological studies. The association
between MCI and self-reported history
of osteoporosis is low, although the
predictive value negative is high. The
study demonstrated a higher preva-
lence of positive MCI signs on PMX
in Chinese women. The study also
demonstrated an association between
osteoporosis and periodontitis.
Acknowledgment
We appreciate the support of Carol Ho-
eller, Karen Manary, Judy Laird, and
student helpers on the T.E.E.T.H. study,
Oral Radiology clinic, and staff mem-
bers of the RCDRC. The present study
was funded by the NIH/NIDCR grant
RO1 DE 12215 and by the Regional
Clinical Dental Research Center
NIDCR grant P30 DEO9743.
Zusammenfassung
Bestimmung parodontaler Bedingungen und
systemischer Erkrankungen bei älteren Pati-
enten. I. Fokus auf Osteoporose
Hintergründe: Osteoporose (OPOR) ist eine
häufig, insbesondere bei älteren Frauen auf-
tretende chronische Erkrankung. Patienten
sind sich oft nicht der Anwesenheit der Er-
krankung bewusst, bis Knochenbrüche auf-
treten. Studien legen den Schluss nahe, dass
OPOR und Parodontitis verwandte Krank-
heiten sind, und durch die Aktivitäten von
Zytokinen verschärft werden. Panorama-
Röntgenaufnahmen (PMX; panoramic ra-
diography) gestatten Untersuchungen des
Rindenknochens (MCI; mandibular cortical
bone), die für OPOR potentiell von diagno-
stischem Wert sind.
Zielsetzung: Ziel der vorliegenden Studie ist
(1) die Untersuchung der Prävalenz einer
selbst berichteten OPOR-Anamnese bei einer
älteren, ethnisch vielschichtigen Population,
(2) die Bestimmung der Übereinstimmung
zwischen PMX / MCI-Ergebnissen und einer
selbst berichteten OPOR, und (3) die Bestim-
mung der Wahrscheinlichkeit einer selbst be-
richteten OPOR und einer Diagnose auf Pa-
rodontitis.
Material und Methodik: Von 1084 Patienten
im Alter von 60 – 75 Jahren (durchschnitt-
liches Alter 67,7, SA ∫ 4,7 Jahre) wurden
PMX angefertigt und eine medizinische An-
amnese erstellt. 90,3% der Röntgenaufnah-
men waren für die Analyse von Wert. Die
PMX wurden durch MCI (Beschreibung
durch Klemetti et al., 1994) untersucht. Die
PMX wurden verwendet, um Patienten als
mit Parodontitis oder mit einem von drei
Schweregraden der Erkrankung einzuteilen.
Ergebnisse: Im Gegensatz zu 8,2% der selbst
berichteten OPOR wurde bei 38,9 % der Pa-
tienten ein positiver MCI beobachtet. Die
Korrelation innerhalb der Klassen zwischen
MCI und selbst berichtetem OPOR lag bei
0,20 (p ⬍ 0.01). Die Wahrscheinlichkeit einer
Beziehung zwischen OPOR und MCI lag bei
2,6 (95 % CI: 1,6, 1,6, 4,1, p ⬍ 0,001). Bei
Patienten mit einem selbst berichteten
OPOR, bestätigt durch MCI, wurde ein
schlechterer parodontaler Zustand beobach-
tet (p ⬍ 0.01). Die Odds Ratio nach Mantel-

Haentzel für OPOR und Parodontitis lag bei
1,8 (95% CI: 1,2, 2,5, p ⬍ 0.001).
Schlussfolgerung: Die Prävalenz von MCI-
Anzeichen einer Osteoporose war hoch und
stimmte mit den epidemiologischen Untersu-
chungen überein, stimmte jedoch nur teilwei-
se mit einer selbst berichteten Osteoporose-
Anamnese mit höherer Prävalenz von MCI
bei chinesischen Frauen überein. Ein hori-
zontaler alveolärer Knochenverlust steht so-
wohl mit MCI, als auch einer selbst berichte-
ten OPOR in Beziehung.
Résumé
Evaluation des conditions parodontales et de
la maladie systémique chez les sujets âgés
L’ostéoporose (OPOR) est une maladie chro-
nique, spécialement rencontrée chez la femme
âgée. Les patients ignorent souvent cette
condition jusqu’au moment où ils souffrent
de fractures osseuses. Des études ont suggéré
que l’OPOR et la parodontite sont des mala-
dies associées et exacerbées par l’activité de
la cytokine. La radiographie panoramique
(PMX) permet d’évaluer l’indice cortical
mandibulaire (MCI) qui représente un dia-
gnostic potentiel pour l’OPOR. Les buts de
cette étude ont été 1) de calculer la fréquence
globlale d’OPOR rapportée par les individus
d’une population d’ethnies diverses, 2) d’éva-
luer l’accord entre les découvertes PMX/MCI
et l’OPOR déclarée, 3) de comparer l’OPOR
déclarée au diagnostic de parodontite. La
PMX et le passé médical ont été obtenus de
1 084 patients de 60 à 75 ans (moyenne
67,6∫4,7). 90,3% des films ont pu être utilisés
pour l’analyse. Les PMX ont été étudiés en
utilisant le MCI. Les PMX servaient à ranger
les patients n’ayant pas de parodontite ou un
des trois degrés de sévérité de cette maladie.
Un MCI positif a été trouvé chez 38,9 % des
sujets contre 8,2% d’OPOR déclarée. La rela-
tion intraclasse entre MCI et OPOR déclarée
par le patient était de 0,20 (p⬍0,01). La pro-
babilité d’une association entre OPOR et
MCI était de 2,6 (95%CI: 1,6, 4,1, p⬍0,001).
Les patients qui avaient une OPOR déclarée
et un MCI positif avaient les conditions pa-
rodontales les pires (p⬍0,01). Les facteurs de
risque Mantel-Haentzel pour l’OPOR et la
parodontite étaient de 1,8 (95%CI: 1,2, 2,5
P⬍0,001). La fréquence globale de MCI po-
sitif était importante et semblable à celle
trouvée lors des études épidémiologiques
mais seulement compatibles en partie avec
l’histoire d’ostéoporose déclarée par le pa-
tient lui-même; Cette fréquence globale était
plus importante chez les chinoises. Une asso-
ciation entre l’ostéoporose et la parodontite
a été démontrée.
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Address:
Dr. G. Rutger Persson
Department of Periodontics
Box 357444 HSB
University of Washington
Seattle, WA 98195, USA
e-mail: rper/u.washington.edu