Association between Periodontitis and Postmenopausal Osteoporosis: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

Haliya ¹ , ZHAO Jin ¹ , LIU Yishan ¹ ,  ZHONG Liangjun ²

1. Department of Periodontal Diseases, First Teaching Hospital of Xinjiang Medical University, Urumqi 830054, China;2. Department of Stomatology of Hangzhou Normal University, Hangzhou 310015, China;

Corresponding author：

ZHONG Liangjun, Email: akejana@hotmail.com

Keywords：

Periodontal disease; Periodontitis; Postmenopausal osteoporosis; Meta-analysis; Case control study

DOI：

10.7507/1672-2531.20110234

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Objective 　To explore the relationship between periodontitis and postmenopausal osteoporosis.
Methods　 Databases were electronically searched from PubMed (1966 to December, 2010), EMbase (1974 to December, 2010), CBM (1978 to December, 2010), VIP (1989 to December, 2010), CNKI (1979 to December, 2010) and WanFang Data (January, 2007 to December, 2010), and the references listed in all papers were also retrieved. The literature was screened according to the inclusion and exclusion criteria by two reviewers independently; the methodology quality was evaluated after data abstraction; and then the RevMan 5.0 software was used for meta-analyses.
Results　 Four trials were included. Among the total 678 patients involved, 263 were postmenopausal osteoporosis patients, while the other 415 were non-osteoporosis patients. The results of meta-analyses showed that: a) Clinical attachment loss (CAL) of the postmenopausal osteoporosis patients was significantly higher than that of the non-osteoporosis patients (WMD=0.60, 95%CI 0.23 to 0.96); b) The level of gingival recession of the postmenopausal osteoporosis patients was significantly higher than that of the non-osteoporosis patients (WMD=0.78, 95%CI 0.41 to 1.14); c) There were no significant differences in plaque index (PI), gingival index (GI) and periodontal probing depth (PPD) between the two groups (WMD=0.17, 95%CI 0.00 to 0.35; WMD=0.05, 95%CI –0.09 to 0.19; and WMD=–0.08, 95%CI –0.24 to 0.09); d) The results of one study indicated that the rate of periodontitis in the postmenopausal osteoporosis patients was higher than that of the non-osteoporosis patients (OR=2.45, 95%CI 1.38 to 4.34, P lt;0.01); the severe alveolar crest height loss was related to osteoporosis (OR=4.20, 95%CI 1.57 to 11.22, P lt;0.01).
Conclusion　 Postmenopausal osteoporosis patients are more prone to suffer from periodontitis or turn to the worse stage of periodontitis. In consideration of the factors such as small scales and incomplete measure indexes of the included studies, which have influences on the intensity and comprehensiveness of this conclusion, more high-quality studies are required.

Citation： Haliya,ZHAO Jin,LIU Yishan,ZHONG Liangjun. Association between Periodontitis and Postmenopausal Osteoporosis: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2011, 11(12): 1377-1383. doi: 10.7507/1672-2531.20110234 Copy

1.	孟焕新, 主编. 牙周炎学. 第3版. 北京: 人民卫生出版社, 2008: 20-31.
2.	Cobb CM, Williams KB, Gerkovitch MM. Is the prevalence of periodontitis in the USA in decline? Periodontol, 2000, 2009, 50: 13-24.
3.	Holtfreter B, Schwahn C, Biffar R, et al. Epidemiology of periodontal diseases in the Study of Health in Pomerania. J Clin Periodontol, 2009, 36(2): 114-123.
4.	卞金有, 主编. 预防口腔医学. 第4版. 北京: 人民卫生出版社, 2006: 30-31.
5.	Geurs NC. Osteoporosis and periodontal disease. Periodontol, 2000, 2007, 44: 29-43.
6.	Groen JJ, Duyvensz F, Halsted JA. Diffuse alveolar atrophy of the jaw (non-inflammatory form of paradental disease and pre-senile osteoporosis. Gerontol Clin, 1960, 2: 68-86.
7.	Boehm, TK, Scannapieco FA. The epidemiology, consequences and management of periodontal disease in older adults. J Am Dent Assoc, 2007, 138(Suppl): S26-S33.
8.	World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser, 1994, 843: 1-129.
9.	曹采方, 主编. 牙周炎学. 第2版. 北京: 人民卫生出版社, 2000: 120.
10.	Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa, Canada: Dept of Epidemiology and Community Medicine, University of Ottawa. http: //www.ohri.ca/programs/-clinical_epidemiology/oxford.htm.
11.	Leonardi-bee J, Smyth A, Britton J, et al. Environmental tobacco smoke and fetal health: systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed, 2008, 93(5): F351-F361.
12.	von Wowern N, Klausen B, Kollerup G. Osteoporosis: A risk factor in periodontal disease. J Periodontol, 1994, 65: 1134-1138.
13.	Mohammad AR, Brunsvold M, Bauer R. The strength of association between systemic postmenopausal osteoporosis and periodontal disease. Int J Prosthodont, 1996, 9(5): 479-483.
14.	Brennan RM, Genco RJ, Hovey KM, et al. Clinical attachment loss, systemic bone density, and subgingival calculus in postmenopausal women. J Periodontol, 2007, 78(11): 2104-2111.
15.	Al Habashneh R, Alchalabi H, Khader YS, et al. Association between periodontal disease and osteoporosis in postmenopausal women in Jordan. J Periodontol, 2010, 81(11): 1613-1621.
16.	Weyant RJ, Pearlstein ME, Churak AP, et al. The association between osteopenia and periodontal attachment loss in older women. J Periodontol, 1999, 70(9): 982-991.
17.	Shen EC, Gau CH, Hsieh YD, et al. Periodontal status in post-menopausal osteoporosis: a preliminary clinical study in Taiwanese women. J Chin Med Assoc, 2004, 67(8): 389-393.
18.	Wactawski-Wende J, Hausmann E, Hovey K, et al. The association between osteoporosis and alveolar crestal height in postmenopausal women. J Periodontol, 2005, 76(11 Suppl): 2116-2124.
19.	Famili P, Cauley J, Suzuki JB, et al. Longitudinal study of periodontal disease and edentulism with rates of bone loss in older women. J Periodontol, 2005, 76(1): 11-15.
20.	Yoshihara A, Seida Y, Hanada N, et al. A longitudinal study of the relationship between periodontal disease and bone mineral density in community-dwelling older adults. J Clin Periodontol, 2004, 31(8): 680-684.
21.	Hildebolt CF, Pilgram TK, Yokoyama-Crothers N, et al. The pattern of alveolar crest height change in healthy postmenopausal women after 3 years of hormone/estrogen replacement therapy. J Periodontol, 2002, 73(11): 1279-1284.
22.	Elders PJ, Habets LL, Netelenbos JC, et al. The relation between periodontitis and systemic bone mass in women between 46 and 55 years of age. J Clin Periodontol, 1992, 19(7): 492-496.
23.	Kribbs PJ. Comparison of mandibular bone in normal and osteoporotic women. J Prosthet Dent, 1990, 63(2): 218-222.
24.	Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. JADA, 2003, 134(2): 220-225.

1. 孟焕新, 主编. 牙周炎学. 第3版. 北京: 人民卫生出版社, 2008: 20-31.
2. Cobb CM, Williams KB, Gerkovitch MM. Is the prevalence of periodontitis in the USA in decline? Periodontol, 2000, 2009, 50: 13-24.
3. Holtfreter B, Schwahn C, Biffar R, et al. Epidemiology of periodontal diseases in the Study of Health in Pomerania. J Clin Periodontol, 2009, 36(2): 114-123.
4. 卞金有, 主编. 预防口腔医学. 第4版. 北京: 人民卫生出版社, 2006: 30-31.
5. Geurs NC. Osteoporosis and periodontal disease. Periodontol, 2000, 2007, 44: 29-43.
6. Groen JJ, Duyvensz F, Halsted JA. Diffuse alveolar atrophy of the jaw (non-inflammatory form of paradental disease and pre-senile osteoporosis. Gerontol Clin, 1960, 2: 68-86.
7. Boehm, TK, Scannapieco FA. The epidemiology, consequences and management of periodontal disease in older adults. J Am Dent Assoc, 2007, 138(Suppl): S26-S33.
8. World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser, 1994, 843: 1-129.
9. 曹采方, 主编. 牙周炎学. 第2版. 北京: 人民卫生出版社, 2000: 120.
10. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa, Canada: Dept of Epidemiology and Community Medicine, University of Ottawa. http: //www.ohri.ca/programs/-clinical_epidemiology/oxford.htm.
11. Leonardi-bee J, Smyth A, Britton J, et al. Environmental tobacco smoke and fetal health: systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed, 2008, 93(5): F351-F361.
12. von Wowern N, Klausen B, Kollerup G. Osteoporosis: A risk factor in periodontal disease. J Periodontol, 1994, 65: 1134-1138.
13. Mohammad AR, Brunsvold M, Bauer R. The strength of association between systemic postmenopausal osteoporosis and periodontal disease. Int J Prosthodont, 1996, 9(5): 479-483.
14. Brennan RM, Genco RJ, Hovey KM, et al. Clinical attachment loss, systemic bone density, and subgingival calculus in postmenopausal women. J Periodontol, 2007, 78(11): 2104-2111.
15. Al Habashneh R, Alchalabi H, Khader YS, et al. Association between periodontal disease and osteoporosis in postmenopausal women in Jordan. J Periodontol, 2010, 81(11): 1613-1621.
16. Weyant RJ, Pearlstein ME, Churak AP, et al. The association between osteopenia and periodontal attachment loss in older women. J Periodontol, 1999, 70(9): 982-991.
17. Shen EC, Gau CH, Hsieh YD, et al. Periodontal status in post-menopausal osteoporosis: a preliminary clinical study in Taiwanese women. J Chin Med Assoc, 2004, 67(8): 389-393.
18. Wactawski-Wende J, Hausmann E, Hovey K, et al. The association between osteoporosis and alveolar crestal height in postmenopausal women. J Periodontol, 2005, 76(11 Suppl): 2116-2124.
19. Famili P, Cauley J, Suzuki JB, et al. Longitudinal study of periodontal disease and edentulism with rates of bone loss in older women. J Periodontol, 2005, 76(1): 11-15.
20. Yoshihara A, Seida Y, Hanada N, et al. A longitudinal study of the relationship between periodontal disease and bone mineral density in community-dwelling older adults. J Clin Periodontol, 2004, 31(8): 680-684.
21. Hildebolt CF, Pilgram TK, Yokoyama-Crothers N, et al. The pattern of alveolar crest height change in healthy postmenopausal women after 3 years of hormone/estrogen replacement therapy. J Periodontol, 2002, 73(11): 1279-1284.
22. Elders PJ, Habets LL, Netelenbos JC, et al. The relation between periodontitis and systemic bone mass in women between 46 and 55 years of age. J Clin Periodontol, 1992, 19(7): 492-496.
23. Kribbs PJ. Comparison of mandibular bone in normal and osteoporotic women. J Prosthet Dent, 1990, 63(2): 218-222.
24. Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. JADA, 2003, 134(2): 220-225.

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