Resumen de Population-Based 5-Year Follow-Up Study in Taiwan of Osteoporosis and Risk of Periodontitis
Wei-Pin Chang, Wei-Chiao Chang
Background: Osteoporosis and periodontitis are both considered global health issues that threaten postmenopausal women and the older population. However, the correlation between osteoporosis and periodontitis is still unclear.
Methods: Using a nationwide Taiwanese population-based database, data from patients with osteoporosis (2003 to 2005; n = 2,527) and 7,575 individuals who were matched to each patient by age and sex were analyzed. All participants were tracked for 5 years from the date of enrollment to observe the percentage of patients who developed periodontitis. Cox proportional hazard regressions were performed to evaluate 5-year periodontitis-free survival rates.
Results: Among the total sample, 3,060 individuals were diagnosed with periodontitis during the 5-year follow-up period: 792 in the study cohort and 2,268 in the comparison cohort. The adjusted hazard ratio for periodontitis in patients with osteoporosis compared with individuals without osteoporosis during the 5-year follow-up was 1.14 (95% confidence interval = 1.05 to 1.24, P <0.01).
Conclusion: This population-based study indicated that patients with osteoporosis may have an increased risk of periodontitis.
Osteoporosis and periodontitis are diseases that affect both men and women with advancing age worldwide. Osteoporosis occurs most often in postmenopausal women and the older population.1-4 Between 1996 and 2006, the average prevalence of osteoporosis was 1.63% for men and 11.35% for women in the Taiwanese older population.1 In addition, a community-based study that enrolled 8,462 individuals indicated a high prevalence (94.8%) of chronic periodontal diseases in Taiwan.2 Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro-architectural deterioration.5 Osteoporosis is considered as a physiologic process associated with aging and is recognized as a multifactorial chronic systemic disease.6 Osteoporosis is an imbalance between bone resorption and bone formation.7 Several cytokines, such as interleukin (IL)-1, IL-6, and macrophage colony-stimulating factor, and hormones (estrogens) are reported to regulate the coupling process and generation of osteoclasts.7,8 Clowes et al.9 indicated that the majority of the hormones and cytokines are important mediators of bone resorption and immune responses. Their observations are consistent with clinical evidence.10 Periodontitis, a set of chronic inflammatory or infected gum conditions, is one of the most common periodontal diseases and involves gradual resorption of alveolar bone and also loss of the soft tissue attachment to the teeth.6 Moderate and advanced periodontitis affects approximately 30% and 10%,11 respectively, of the adult population of the United States. Deep periodontal pockets are present in 2% to 18% of adults in Western countries and have a higher prevalence in developing countries.6 Periodontitis and osteoporosis are common in the older population.4,12 Several studies13-17 tested the possible association between these two diseases. However, the evidence is contradictory; some studies found an association between osteoporosis and periodontal bone loss and tooth loss,13,16,17 whereas other studies indicated that there was no significant association between bone mineral density and alveolar bone loss.14,15 In cross-sectional studies, Payne et al.16 and Tezal et al.17 provided evidence to support a close association between severity of periodontal disease and osteoporosis in Western countries.
