Osteoporosis and Periodontitis: Two-Way Epidemiological and Mechanistic Evidence

Osteoporosis and periodontitis are highly prevalent, chronic inflammatory diseases that constitute a major global health burden. Strong epidemiological evidence shows an association between the two diseases, in which osteoporosis patients have an increased risk of periodontitis, specifically in postmenopausal women. Osteoporosis and periodontitis are linked by bidirectional relationships through shared inflammatory and bone-resorptive pathways. Such a connection is explained by shared osteo-immunologic pathways, particularly as highlighted by recent breakthrough findings in the field. In this review, we comprehensively examined the seven links between osteoporosis and periodontitis across microbial translocation, systemic meta-inflammation, maladaptive myelopoiesis, immune cell trafficking, masticatory dysfunction-diet interactions, underlying vulnerabilities, and functional alterations of the oral microbiome, drawing on current biological findings and clinical evidence. This bidirectional relationship underscores the importance of integrated medical and dental screening and management strategies to improve patient outcomes for both conditions.