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Journal ArticleDOI

Longitudinal Alveolar Bone Loss in Postmenopausal Osteoporotic/Osteopenic Women

TL;DR: The data suggest that osteoporosis/osteopenia and estrogen deficiency are risk factors for alveolar bone density loss in postmenopausal women with a history of periodontitis.
Abstract: The purpose of this 2-year longitudinal clinical study was to investigate alveolar (oral) bone height and density changes in osteoporotic/osteopenic women compared with women with normal lumbar spine bone mineral density (BMD) Thirty-eight postmenopausal women completed this study; 21 women had normal BMD of the lumbar spine, while 17 women had osteoporosis or osteopenia of the lumbar spine at baseline All subjects had a history of periodontitis and participated in 3- to 4-month periodontal maintenance programs No subjects were current smokers All patients were within 5 years of menopause at the start of the study Four vertical bitewing radiographs of posterior sextants were taken at baseline and 2-year visits Radiographs were examined using computer-assisted densitometric image analysis (CADIA) for changes in bone density at the crestal and subcrestal regions of interproximal bone Changes in alveolar bone height were also measured Radiographic data were analyzed by the t-test for two independent samples Osteoporotic/osteopenic women exhibited a higher frequency of alveolar bone height loss (p<005) and crestal (p<0025) and subcrestal (p<003) density loss relative to women with normal BMD Estrogen deficiency was associated with increased frequency of alveolar bone crestal density loss in the osteoporotic/osteopenic women and in the overall study population (p<005) These data suggest that osteoporosis/osteopenia and estrogen deficiency are risk factors for alveolar bone density loss in postmenopausal women with a history of periodontitis
Citations
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Journal ArticleDOI
TL;DR: Evidence from studies that evaluated thresholds for serum 25(OH)D concentrations in relation to bone mineral density, lower-extremity function, dental health, and risk of falls, fractures, and colorectal cancer suggests that an increase in the currently recommended intake of vitamin D is warranted.

2,357 citations

Journal ArticleDOI
TL;DR: A conspicuous lack of uniformity in the definition of periodontitis used in epidemiologic studies, and findings from different research groups are not readily interpretable, means there is a clear need for longitudinal prospective studies that address hypotheses emerging from the cross-sectional data and include established risk factors as covariates along with new exposures of interest.
Abstract: Aims: To review the literature related to the analytical epidemiology of periodontitis generated over the past decade. This review does not deal with descriptive epidemiologic studies of the prevalence, extent and severity of periodontitis with respect to global geography, but focuses exclusively on analytical epidemiology issues, including the challenges posed by the use of different case definitions across studies, current theories and models of disease progression, and risk factors associated with the onset and progression of periodontitis. Methods: Relevant publications in the English language were identified after Medline and PubMed database searches. Findings and conclusions: There is a conspicuous lack of uniformity in the definition of periodontitis used in epidemiologic studies, and findings from different research groups are not readily interpretable. There is a lack of studies that specifically address the distinction between factors responsible for the onset of periodontitis versus those affecting its progression. Colonization by specific bacteria at high levels, smoking, and poorly controlled diabetes have been established as risk factors for periodontitis, while a number of putative factors, including specific gene polymorphisms, have been identified in association studies. There is a clear need for longitudinal prospective studies that address hypotheses emerging from the cross-sectional data and include established risk factors as covariates along with new exposures of interest. Intervention studies, fulfilling the “targeting” step of the risk assessment process, are particularly warranted. Obvious candidates in this context are studies of the efficacy of elimination of specific bacterial species and of smoking cessation interventions as an alternative to the traditional broad anti-plaque approach in the prevention and control of periodontitis. Ideally, such studies should have a randomized-controlled trial design.

363 citations

Journal ArticleDOI
TL;DR: Periodontal diseases are chronic inflammatory disorders encompassing destructive and nondestructive diseases of the periodontal supporting tissues of teeth that are most prevalent among adults and seniors world-wide and with important modifying effects from other local and systemic factors.

328 citations


Cites background from "Longitudinal Alveolar Bone Loss in ..."

  • ...There is incomplete information about the relationship of periodontal tissue loss with other systemic diseases and conditions such as osteopenia and osteoporosis [109,110] and arthritis [56,111]....

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Journal ArticleDOI
TL;DR: Low serum 25(OH)D(3) concentrations may be associated with PD independently of BMD and given the high prevalence of PD and vitamin D deficiency, these findings may have important public health implications.

313 citations

Journal ArticleDOI
TL;DR: In this paper, the effect of calcium and vitamin D supplements on bone loss from the hip, as well as a 2-year follow-up study after discontinuation of study supplements was investigated.

272 citations

References
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Journal ArticleDOI
TL;DR: Patients in a private periodontal practice were reexamined an average of 22 years after their active treatment and the patterns of tooth loss were observed and tooth retention seemed more closely related to the case type than the surgery performed.
Abstract: 1. Six hundred patients in a private periodontal practice were reexamined an average of 22 years after their active treatment and the patterns of tooth loss were observed. 2. During the post-treatment period, 300 patients had lost no teeth from periodontal disease, 199 had lost one to three teeth, 76 had lost 4 to 9 teeth and 25 had lost 10 to 23 teeth. 3. Of 2,139 teeth that originally had been considered of questionable prognosis, 666 were lost. Of these, 394 were lost by one sixth of the patients and only 272 by the other five-sixths. 4. Of 1,464 teeth which originally had furcation involvements, 460 were lost, 240 of them by one-sixth of the patients who deteriorated most. 5. The mortality of teeth which were treated with periodontal surgery was compared with that of teeth which did not have surgery. Tooth retention seemed more closely related to the case type than the surgery performed. 6. In general, periodontal disease is bilaterally symmetrical and there is a predictable order of likelihood of tooth loss according to position in the arch.

894 citations

Journal ArticleDOI
TL;DR: periodontal disease appears to be bilaterally symmetrical and tooth loss response emulated this pattern with greatest loss of maxillary second molars and least loss of mandibular cuspids.
Abstract: A population of 100 patients with periodontal disease who had been treated and maintained for 15 years or longer was studied for tooth loss. The patients averaged 43.8 years of age and consisted of 59 females and 41 males. Patients were examined and their dental records were reviewed. On the basis of response to therapy and tooth loss, the patients were classified as Well-Maintained (77), Downhill (15), or Extreme Downhill (8). At the completion of initial treatment, 2,627 teeth were present. Of this number, during the maintenance period, 259 teeth (9.8%) were lost due to periodontal disease, while 40 teeth (1.5%) were lost due to other causes. Evaluation was made as to patterns of tooth loss, loss of questionable teeth, loss of teeth with furcations, surgical vs. nonsurgical therapy, and presence of fixed or removable prostheses. Considerable variation occurred between response groups. Periodontal disease appears to be bilaterally symmetrical and tooth loss response emulated this pattern with greatest loss of maxillary second molars and least loss of mandibular cuspids.

524 citations

Journal ArticleDOI
TL;DR: Analysis based on an independent data source of non-federal hospital discharges in Washington, DC confirmed that White women were at twice the risk for hip fracture compared with Black women and at 2.7 times the risk compared to White men.
Abstract: Incidence rates for hip fracture in the United States were estimated using non-federal hospital discharges from the National Hospital Discharge Survey for the years 1974-1979. Age-specific incidence curves for women and for men showed similar patterns of increase in risk with age, with risks approximately doubling every five years after age 50. Age-specific rates by five-year age groups were compared among the four race-sex groups. No significant differences were observed between Black females, Black males, and White males. In contrast, rates for White females were one and one-half to four times those for Black females after age 40 and were approximately double those for White males after age 50. Analysis based on an independent data source of non-federal hospital discharges in Washington, DC confirmed these relationships. In the Washington study, White women were at twice the risk for hip fracture (controlled for age) compared with Black women and at 2.7 times the risk for hip fracture (controlled for age) compared to White men. No significant differences were observed between Black women and Black men.

386 citations


"Longitudinal Alveolar Bone Loss in ..." refers background in this paper

  • ...Fourth, all subjects in this study were Caucasian (including one Hispanic);Caucasiansare most susceptible to the effectsof osteoporosis/osteopenia [25]....

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Journal ArticleDOI
TL;DR: Whether a deficit in bone density is associated with tobacco use and, if so, to identify the responsible mechanisms is ascertained.
Abstract: Background Smoking is recognized as a risk factor for vertebral, forearm, and hip fractures. Since bone density is an important determinant of bone strength, we conducted a study to ascertain whether a deficit in bone density is associated with tobacco use and, if so, to identify the responsible mechanisms. Methods We conducted a cross-sectional study of bone density at the lumbar spine and the femoral neck and shaft in 41 pairs of female twins (21 monozygotic pairs), 27 to 73 years of age (mean, 49), who were discordant for at least 5 pack-years of smoking (mean, 23; maximum, 64). Bone density was measured by dual-photon absorptiometry. The difference in bone density between the members of a pair was expressed as a percentage of the mean value for the pair. Results For every 10 pack-years of smoking, the bone density of the twin who smoked more heavily was 2.0 percent lower at the lumbar spine (P = 0.01), 0.9 percent lower at the femoral neck (P = 0.25), and 1.4 percent lower at the femoral shaft (P = 0....

383 citations


"Longitudinal Alveolar Bone Loss in ..." refers background in this paper

  • ...Smoking is a potentially confounding variable since it is associated with oral [22] and systemic bone loss [ 23 ]....

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Journal ArticleDOI
TL;DR: The hypothesis is that alterations in IL-1 production may underlie the postmenopausal acceleration in bone loss and its inhibition by ovarian steroids and is based on data from prospective and prospective studies.
Abstract: In previous studies, we showed that blood monocyte elaboration of interleukin 1 (IL-1), a known stimulator of bone resorption, was higher in osteoporotic patients with rapid bone turnover than in those with slow turnover and in nonosteoporotic subjects. Since an acceleration of bone loss following menopause contributes to the risk of osteoporosis in women, we have studied the effects of menopause and ovarian steroid treatment on IL-1 release by monocytes obtained from nonosteoporotic and osteoporotic women. IL-1 activity in the monocyte culture medium derived from untreated postmenopausal women (nonosteoporotic and osteoporotic) was higher than in the medium derived from either untreated premenopausal or estrogen/progesterone-treated postmenopausal women. A significant negative correlation was found between IL-1 and years since menopause in both the healthy (r = -0.75; P less than 0.005) and the osteoporotic (r = -0.61; P less than 0.01) untreated postmenopausal women. The difference between the two slopes was significant at P less than 0.05. Premenopausal IL-1 levels were achieved within 8 years of menopause in the nonosteoporotic, but not in the osteoporotic, subjects in whom increases were evident as long as 15 years after menopause. IL-1 also correlated inversely with vertebral mineral density (r = -0.37; P less than 0.05), as measured by quantitative computed tomography. In prospective studies, treatment with estrogen/progesterone for 1 month caused a substantial highly significant decrease in IL-1 activity in each of three nonosteoporotic and five osteoporotic women, confirming the apparent effect of hormone therapy observed in the cross-sectional analysis. Although a cause-effect relationship has not been established, it is our hypothesis, based on these data, that alterations in IL-1 production may underlie the postmenopausal acceleration in bone loss and its inhibition by ovarian steroids. Persistent elevation of IL-1 secretion appears to be a feature of postmenopausal osteoporosis.

370 citations