Assessment of periodontal conditions and systemic disease in older subjects - I. Focus on osteoporosis

Background: Osteoporosis (OPOR) is a common chronic disease, especially in older women. Patients are often unaware of the condition until they experience bone fractures. Studies have suggested that OPOR and periodontitis are associated diseases and exaggerated by cytokine activity. Panoramic radiography (PMX) allows studies of mandibular cortical index (MCI), which is potentially diagnostic for OPOR. Aims: i) To study the prevalence of self-reported history of OPOR in an older, ethnically diverse population, ii) to assess the agreement between PMX/MCI findings and self-reported OPOR, and iii) to assess the likelihood of having both a self-reported history of OPOR and a diagnosis of periodontitis. Materials and methods: PMX and medical history were obtained from 1084 subjects aged 60-75 (mean age 67.6, SD +/- 4.7). Of the films, 90.3% were useful for analysis. PMXs were studied using MCI. The PMXs were used to grade subjects as not having periodontitis or with one of three grades of periodontitis severity. Results: A positive MCI was found in 38.9% of the subjects, in contrast to 8.2% self-reported OPOR. The intraclass correlation between MCI and self-reported OPOR was 0.20 (P<0.01). The likelihood of an association between OPOR and MCI was 2.6 (95%CI: 1.6, 4.1, P<0.001). Subjects with self-reported OPOR and a positive MCI had worse periodontal conditions (P<0.01). The Mantel-Haentzel odds ratio for OPOR and periodontitis was 1.8 (95%CI: 1.2, 2.5, P<0.001). Conclusions: The prevalence of positive MCI was high and consistent with epidemiological studies, but only partly consistent with a self-reported history of osteoporosis with a higher prevalence of positive MCI in Chinese women. Horizontal alveolar bone loss is associated with both positive self-reported OPOR and MCI.