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JDR Clin Trans Res. 2018 Oct;3(4):378-387. doi: 10.1177/2380084418787451. Epub 2018 Jul 9.

Effects of Bone Fragility and Antiresorptive Drugs on Periodontal Disease and Tooth Loss: A Longitudinal Study.

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1 Department of Preventive Dentistry, Odontoclínica Central da Marinha, Brazilian Navy, Rio de Janeiro, Brazil.
2 Division of Periodontics, Department of Dental Clinic, Dental School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
3 Department of Oral Pathology and Diagnosis, Dental School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
4 Division of Endocrinology, Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
5 Rheumatology Department, Hospital Naval Marcilio Dias, Rio de Janeiro, Brazil.
6 Rheumatology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
7 Rheumatology Department, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil.
8 Academic Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.


This longitudinal study aimed to elucidate whether systemic bone fragility predicts severe periodontal clinical attachment loss (CAL) and tooth loss over the years and to test the influence of bone medication and periodontal maintenance in these relationships. Elderly women were evaluated for bone mineral density (BMD) and for fracture risk assessment (FRAX) in a cross-sectional analysis and retrospective follow-up (6- and 10-y periods). Data on BMD and FRAX were used as indicators of bone fragility in structural equation modeling. Periodontal examination and data on postmenopausal tooth loss were recorded. Multivariate Poisson regression models with robust covariance were used to estimate relative risk (RR) and 95% CI of BMD and FRAX for sites with CAL ≥6 mm and for tooth loss. The cross-sectional analysis included 134 women aged 65 to 80 y, and from them 71 and 49 women had available data for analysis in the 6- and 10-y follow-up periods, respectively. Bone fragility predicted severe CAL over 10 y (e.g., femoral neck: 10-y analysis, β = -0.389, P = 0.005; cross-sectional, β = -0.190, P = 0.004); however, this association did not remain significant when the use of bone medication was evaluated. Poisson regression showed that a better skeletal condition was associated with a lower risk of severe periodontal disease and tooth loss (cross-sectional femoral neck: RR = 0.08, P < 0.001; RR = 0.03, P < 0.001, respectively) when not adjusted for bone medication and periodontal maintenance. The receiver operating characteristic curve suggested that women with osteoporosis should be referred for periodontal assessment (sensitivity = 71.0%, specificity = 70.0%). Bone fragility is a relevant longitudinal predictor of severe periodontal disease and tooth loss among elderly women. The use of bisphosphonates improved the bone condition as well as the periodontal status. Periodontal maintenance also minimized the negative impact of low BMD on teeth-supportive tissues in the studied population. Knowledge Transfer Statement: The results of this study present evidence that the management of bone fragility and osteoporosis may be important in the prevention of periodontal attachment loss and future tooth loss. Besides the antiresorptive effects of the antiosteoporosis drugs on systemic bone conditions, these medications may protect periodontal tissues. The interaction of health care professionals such as dentists and physicians represents a key role for the approach to women's health, especially in an aging world.


bisphosphonates; bone density; elderly; oral health; osteoporosis; periodontal attachment loss


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