Clinical attachment loss, systemic bone density, and subgingival calculus in postmenopausal women

Results of several studies investigating associations between systemic bone density and clinical attachment loss (CAL) of the soft tissue surrounding the teeth have varied. We investigated these associations in a relatively large study while evaluating potential confounding factors and effect modification by subgingival calculus and age.

In a cross-sectional study of 1,329 postmenopausal women recruited from the Buffalo Women's Health Initiative Observational Study, systemic bone density was measured at the spine, hip, forearm, and whole body by dual-energy x-ray absorptiometry, and a complete oral health examination was conducted.

We found the strongest associations between systemic bone density and CAL among women without subgingival calculus. Results were adjusted for age, cigarette smoking, education, and time since last dental cleaning. Presence or absence of subgingival calculus was a strong effect modifier. Among women without subgingival calculus, there were consistent inverse associations between systemic bone mineral density (BMD) and CAL (total forearm BMD beta=-1.308; P=0.001). Among women with subgingival calculus, there were no associations between systemic BMD and CAL (total forearm BMD beta=-0.153; P=0.677).

Our results provide evidence of an association between osteoporosis and one measure of periodontal disease severity, CAL. The associations between bone density, CAL, and subgingival calculus require further research, particularly in longitudinal studies.