title: Beneficial effects of hormone replacement therapy on periodontitis are vitamin D associated.
abstract: BACKGROUND
  Possible synergism between female sex hormones and vitamin D on periodontitis pathology has not been assessed. Here, the authors investigate effects of estrogen, progesterone, and vitamin D on periodontitis in a population-based sample and use cell studies to explore mechanistic explanations of the population-based findings.
  
  
  METHODS
  The epidemiologic analysis uses cross-sectional data from the continuous National Health and Nutrition Examination Survey 2001 to 2004. The cross sections include 1,230 women aged 40 to 85 years who received a periodontal examination, responded to questions regarding hormone replacement therapy (HRT), and provided a blood sample for serum vitamin D assessments. For mechanistic cell culture studies, human monocytes were cultured with or without lipopolysaccharide (LPS), estradiol, progesterone, and/or 1,25-dihydroxyvitamin D3; and transcriptional activity of interleukin (IL)-6, IL-1β, B lymphocyte chemoattractant (BLC), and regulated on activation normal T-cell expressed and secreted (RANTES) was assessed.
  
  
  RESULTS
  HRT use (versus none) was associated with higher attachment levels and more teeth only among participants who were vitamin D sufficient (>20 ng/mL). The odds ratio for having moderate/severe periodontitis among users of HRT versus participants who did not use HRT was 0.69 among participants who were vitamin D sufficient and 1.19 in participants who were vitamin D deficient. LPS-induced IL-6, IL-1β, and BLC expression was attenuated in human monocytes treated with estrogen and progesterone. Downregulation of IL-6 expression by estrogen and progesterone was potentiated when vitamin D was included. LPS-induced IL-6 and RANTES expression was decreased, and BLC expression was totally reversed, by vitamin D treatment.
  
  
  CONCLUSIONS
  The association between HRT and clinical periodontal measures was strongest among women with high vitamin D levels. This association is plausibly mediated via an anti-inflammatory transcriptional mechanism.
authors.affiliation: Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden. daniel.jonsson@mah.se
authors.forename: Daniel
authors.initials: D
authors.lastname: Jönsson
authors.forename: Prerna
authors.initials: P
authors.lastname: Aggarwal
authors.forename: Bengt-Olof
authors.initials: BO
authors.lastname: Nilsson
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Demmer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001402:B-Lymphocytes / Q000187:drug effects; D002117:Calcitriol / Q000627:therapeutic use; D002460:Cell Line; D018946:Chemokine CCL5 / Q000187:drug effects; D002630:Chemotactic Factors / Q000032:analysis; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004926:Escherichia coli; D004958:Estradiol / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D053583:Interleukin-1beta / Q000187:drug effects; D015850:Interleukin-6 / Q000032:analysis; D008070:Lipopolysaccharides / Q000494:pharmacology; D008213:Lymphocyte Activation / Q000187:drug effects; D008875:Middle Aged; D009000:Monocytes / Q000187:drug effects; D017622:Periodontal Attachment Loss / Q000145:classification; D010518:Periodontitis / Q000145:classification*; D011159:Population Surveillance; D011374:Progesterone / Q000627:therapeutic use; D013601:T-Lymphocytes / Q000187:drug effects; D016388:Tooth Loss / Q000145:classification; D014807:Vitamin D / Q000097:blood / Q000627:therapeutic use*
chemical_list: C483024:CCL5 protein, human; D018946:Chemokine CCL5; D002630:Chemotactic Factors; C508600:IL6 protein, human; D053583:Interleukin-1beta; D015850:Interleukin-6; D008070:Lipopolysaccharides; D014807:Vitamin D; D011374:Progesterone; D004958:Estradiol; D002117:Calcitriol