Oestrogen treatment for postmenopausal osteoporosis may prevent periodontal disease
Postmenopausal women receiving oestrogen treatment for osteoporosis had a lower prevalence of periodontal disease compared with those who were not receiving oestrogen treatment, a recent study has shown.
“This study showed a negative association between osteoporosis treatment with [oestrogen] in postmenopausal women and severe periodontitis … Women in the osteoporosis treatment group had smaller average probing depth and less clinical attachment loss, and a lower percentage of bleeding sites on probing,” said the researchers.
After adjusting for sociodemographic variables and dental visits, severe periodontitis was less frequent among oestrogen-treated women compared with nontreated women (adjusted prevalence ratio, 0.56, 95 percent confidence interval, 0.31–0.99; p=0.05). [Menopause 2017;doi:10.1097/GME.0000000000000830]
The number of missing teeth was the most frequent component in the estimated mean Decayed, Missing, and Filled Teeth Index (DMFT) score (9 out of approximately 20 units) in the osteoporosis treatment arm. Missing teeth may affect periodontal evaluation, noted the researchers, hence the need for further evaluation of tooth loss caused by postmenopausal oestrogen deficiency.
However, they emphasized that evaluating clinical periodontal parameters (eg, DMFT, probing depth, clinical attachment level) separately may not exactly indicate the existence of periodontitis. “An individual may have one of the parameters altered, but no diagnosis of periodontitis,” they said.
Overall, the findings were consistent with previous studies showing the protective impact of osteoporosis treatment, not only against osteoporosis but periodontal disease as well. [Arch Intern Med 2002;162:1409-1415; Menopause 2004;11:556-562; Clin Oral Investig 2008;12:271-277]
Subjects in this cross-sectional study were 492 postmenopausal women (mean age, 60.6 years), 356 of whom were diagnosed with osteoporosis or osteopenia, and 90 with periodontitis. One hundred and thirteen of the osteoporotic participants had been treated with either systemic oestrogen alone or oestrogen plus progestin, as well as calcium and vitamin D supplements for at least 6 months.
Tooth loss due to dental caries was a primary factor behind the high prevalence of missing teeth in periodontally compromised patients, suggesting that patients preferred tooth extraction over preservation, said the researchers.
The study underlines the importance of a preventive approach in periodontal management, they said, recommending further investigation to establish a definite link between osteoporosis treatment and periodontal disease and tooth loss prevention.
The 6-month treatment time limited the findings, as the therapeutic effect of oestrogen treatment requires a significant exposure time, they added.