Low bone density and periodontal disease in postmenopausal women: A systematic review and meta-analysis

Osteoporosis has been reported among many postmenopausal women (PMW). Studies also evaluated the link between osteoporosis and periodontitis. However, to date, the relationship between these two conditions remains unclear. Therefore, we systematically reviewed the current literature to answer the PECO question "Is there a relationship between low bone mineral density (BMD) and periodontitis in terms of clinical attachment loss among PMW?"

Two authors independently searched the major databases using various MesH terms and keywords to identify and screen studies that fulfilled the eligibility criteria. Critical appraisal tools were used to measure the methodological quality of included studies. GRADE evaluation and meta-analysis were also performed.

Seventeen studies (3689 participants) were finally included in the review. The majority of the included studies (n = 14) showed an association between low BMD/osteoporosis and periodontitis among PMW. The risk of bias was measured as moderate among the cross-sectional studies and low in case-control studies. Meta-analysis revealed high heterogeneity among the studies (I ² = 91%). Increased clinical attachment loss in osteoporosis was observed compared to the control group (pooled standard mean difference = 0.75 (0.22-1.28) with P < 0.001). Sensitivity analysis was also done by eliminating the studies with a high risk of bias. The GRADE quality of evidence was low among the studies indicating more clinical research to support the findings.

This systematic review and meta-analysis found a relationship between low BMD/osteoporosis and periodontitis. However, more longitudinal studies with larger sample sizes are required to support the findings of this review.