title: Changes in Inflammatory and Bone Turnover Markers After Periodontal Disease Treatment in Patients With Diabetes.
abstract: BACKGROUND
  The underlying mechanisms for increased osteopenia and fracture rates in patients with diabetes are not well understood, but may relate to chronic systemic inflammation. We assessed the effect of treating periodontal disease (POD), a cause of chronic inflammation, on inflammatory and bone turnover markers in patients with diabetes.
  
  
  METHODS
  Using an investigator-administered questionnaire, we screened a cross-section of patients presenting for routine outpatient diabetes care. We recruited 22 subjects with POD. Inflammatory and bone turnover markers were measured at baseline and 3 months following POD treatment (scaling, root planing and subantimicrobial dose doxycycline).
  
  
  RESULTS
  There were nonsignificant reductions in high-sensitivity C-reactive protein (6.34-5.52mg/L, P = 0.626) and tumor necrosis factor-alpha (10.37-10.01pg/mL, P = 0.617). There were nonsignificant increases in urinary C-terminal telopeptide (85.50-90.23pg/mL, P = 0.684) and bone-specific alkaline phosphatase (7.45-8.79pg/mL, P = 0.074). Patients with >90% adherence with doxycycline were 6.4 times more likely to experience reduction in tumor necrosis factor-alpha (P = 0.021) and 2.8 times more likely to experience reductions in high-sensitivity C-reactive protein (P = 0.133).
  
  
  CONCLUSIONS
  Treatment of POD in patients with diabetes resulted in nonsignificant lowering of inflammatory markers and nonsignificant increase in bone turnover markers. However, adherence to doxycycline therapy resulted in better treatment effects.
authors.affiliation: Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, Nevada. Electronic address: kizuora@medicine.nevada.edu.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Izuora
authors.affiliation: Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, Nevada; School of Community Health Sciences, University of Nevada, Las Vegas, Nevada.
authors.forename: Echezona E
authors.initials: EE
authors.lastname: Ezeanolue
authors.affiliation: School of Dental Medicine, University of Nevada, Las Vegas, Nevada.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Neubauer
authors.affiliation: School of Dental Medicine, University of Nevada, Las Vegas, Nevada.
authors.forename: Civon L
authors.initials: CL
authors.lastname: Gewelber
authors.affiliation: Office of Medical Research, University of Nevada School of Medicine, Las Vegas, Nevada.
authors.forename: Gayle L
authors.initials: GL
authors.lastname: Allenback
authors.affiliation: School of Community Health Sciences, University of Nevada, Las Vegas, Nevada.
authors.forename: Guogen
authors.initials: G
authors.lastname: Shan
authors.affiliation: Department of Endocrinology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Guillermo E
authors.initials: GE
authors.lastname: Umpierrez
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D024042:Collagen Type I / Q000652:urine; D012534:Dental Scaling / Q000379:methods; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism*; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000652:urine; D010510:Periodontal Diseases / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D010865:Pilot Projects; D016745:Root Planing / Q000379:methods*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D000469:Alkaline Phosphatase; D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein; D024042:Collagen Type I; D004318:Doxycycline; D006442:Glycated Hemoglobin; D010455:Peptides; D014409:Tumor Necrosis Factor-alpha; C439524:TNF protein, human; C052929:collagen type I trimeric cross-linked peptide; C517652:hemoglobin A1c protein, human
keywords: Bone turnover markers; Diabetes complications; Inflammation markers; Periodontal disease