title: Can the FRAX tool be a useful aid for clinicians in referring women for periodontal care?
abstract: OBJECTIVE
  This study aims to compare periodontitis severity in postmenopausal women whose FRAX (World Health Organization Fracture Risk Assessment Tool) scores indicate a major risk for osteoporotic fracture (OPF) versus controls.
  
  
  METHODS
  Participant charts from the Case/Cleveland Clinic Postmenopausal Wellness Collaboration 853-sample database were selected based on the following inclusion criteria: (1) aged between 51 and 80 years; (2) menopause for more than 1 year but less than 10 years; (3) nonsmoker; (4) hemoglobin A1c less than 7; and (5) no glucocorticoid, hormone, RANKL (receptor activator of nuclear factor-κB ligand) inhibitor, or bisphosphonate therapy within 5 years. FRAX score was calculated, and participants were organized into two groups: women with major OPF risk (FRAX scores >20%) and controls. Periodontal data were obtained from the charts. T test was used to assess differences in periodontal parameters between groups.
  
  
  RESULTS
  Ninety participants had FRAX scores higher than 20% and were considered to have high OPF risk; 98 participants served as controls. Probing depth (mean [SD], 2.75 [0.66] vs 2.2 [0.57]), clinical attachment loss (3.15 [0.78] vs 2.73 [0.66]), alveolar bone height (0.58 [0.03] vs 0.60 [0.02]), and tooth loss (5.6 [1.96] vs 3.84 [1.94]) were significantly different between groups, whereas plaque score and bleeding on probing were not.
  
  
  CONCLUSIONS
  Postmenopausal women whose FRAX scores suggest major OPF risk have significantly more severe periodontitis endpoints than controls even though oral hygiene scores do not significantly differ. These findings suggest to clinicians treating women after menopause that referral to a periodontist for disease screening may be appropriate for those women with high fracture risk based on FRAX scores.
authors.affiliation: From the 1Center for Specialized Women's Health, Women's Health Institute, Cleveland Clinic, Cleveland, OH; and 2Department of Periodontology, Case School of Dental Medicine, Case Western Reserve University, Cleveland, OH.
authors.forename: Foluke
authors.initials: F
authors.lastname: Alli
authors.forename: Gazabpreet K
authors.initials: GK
authors.lastname: Bhandal
authors.forename: Holly L
authors.initials: HL
authors.lastname: Thacker
authors.forename: Leena
authors.initials: L
authors.lastname: Palomo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications; D058866:Osteoporotic Fractures; D010518:Periodontitis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D017698:Postmenopause / Q000502:physiology*; D018570:Risk Assessment; D012307:Risk Factors; D016388:Tooth Loss / Q000209:etiology