title: Severe loss of clinical attachment level: an independent association with low hip bone mineral density in postmenopausal females.
abstract: BACKGROUND
  Bone loss is a feature of both periodontitis and osteoporosis, and several studies have analyzed whether the periodontal destruction could have been influenced by systemic bone loss. The aim of this study is to assess the association between clinical attachment level (CAL) and bone mineral density (BMD) at the lumbar spine and hip, lifestyle, smoking, sociodemographic factors, and dental clinical variables in postmenopausal women.
  
  
  METHODS
  One hundred forty-eight women were interviewed using a structured written questionnaire and clinically examined. The periodontal examination, which was performed by calibrated investigators, included CAL, probing depth, gingival recession, bleeding on probing (BOP), visible plaque, supragingival calculus, and mean tooth loss. The sample was stratified into two groups: moderate and severe CAL. The moderate group had all sites with CAL ≤5 mm. The severe group had ≥1 site with CAL >5 mm. BMD, measured using dual-energy x-ray absorptiometry, was assessed at the lumbar spine, femoral neck, and total femur (grams per square centimeters).
  
  
  RESULTS
  Severe CAL was identified in 86 women (58.1%). The multiple linear regression analysis using CAL (dependent variable), adjusted by menopause, education, and family income, demonstrated an inverse relationship of severe CAL with the BMD of the femoral neck (P = 0.015), as well as a positive association of severe CAL with tooth loss (P = 0.000), BOP (P = 0.004), and heavy smokers (P = 0.001).
  
  
  CONCLUSIONS
  Our study demonstrated that severe CAL was associated with low BMD of the femoral neck and deleterious clinical dental parameters and smoking. Our findings suggest that, in addition to appropriate oral care, individuals with severe CAL may also require additional attention to their systemic bone health.
authors.affiliation: Department of Periodontics, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Valéria
authors.initials: V
authors.lastname: Gondim
authors.forename: Juliana
authors.initials: J
authors.lastname: Aun
authors.forename: Cassia Tiemi
authors.initials: CT
authors.lastname: Fukuda
authors.forename: Liliam
authors.initials: L
authors.lastname: Takayama
authors.forename: Maria do Rosário
authors.initials: Mdo R
authors.lastname: Latorre
authors.forename: Cláudio Mendes
authors.initials: CM
authors.lastname: Pannuti
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Rodrigues Pereira
authors.forename: Giuseppe Alexandre
authors.initials: GA
authors.lastname: Romito
mesh_terms: D000368:Aged; D015519:Bone Density; D061827:Dimensional Measurement Accuracy; D005260:Female; D005270:Femur Head / Q000473:pathology*; D005272:Femur Neck / Q000473:pathology*; D006801:Humans; D008019:Life Style; D016014:Linear Models; D008159:Lumbar Vertebrae / Q000473:pathology*; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications* / Q000473:pathology; D017622:Periodontal Attachment Loss / Q000150:complications* / Q000473:pathology; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016388:Tooth Loss / Q000150:complications