title: Bone Density and Clinical Periodontal Attachment in Postmenopausal Women: A Systematic Review and Meta-Analysis.
abstract: Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and has been considered a risk factor for periodontal disease. The aim of this systematic review and meta-analysis was to verify the scientific evidence for the association of periodontal attachment loss with low BMD in postmenopausal women. A systematic search of the literature was performed in databases until August 2016, in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eligibility criteria included studies that compared clinical attachment loss (CAL) between postmenopausal women with low and normal BMD. Studies using similar methodology, with lower and higher risk of bias, were pooled into 3 different meta-analyses to compare CAL among women with normal BMD, osteoporosis, and osteopenia. In the first meta-analysis, mean CAL was compared among groups. In the other 2 meta-analyses, the mean percentages of sites with CAL ≥4 mm and ≥6 mm were respectively compared among groups. From 792 unique citations, 26 articles were selected for the qualitative synthesis. Eleven of the studies were appraised as presenting low risk of bias, and the association between low BMD and CAL was observed in 10 of these studies. Thirteen cross-sectional articles were included in the meta-analysis for osteoporosis and 9 in the osteopenia analysis. Women with low BMD presented greater mean CAL than those with normal BMD (osteoporosis = 0.34 mm [95% confidence interval (CI), 0.20-0.49], P < 0.001; osteopenia = 0.07 mm [95% CI, 0.01-0.13], P = 0.02). Only studies with lower risk of bias were available for the analysis of CAL severity. Women with low BMD presented more severe attachment loss, represented as mean percentage of sites with CAL ≥4 mm (osteoporosis = 3.04 [95% CI, 1.23-4.85], P = 0.001; osteopenia = 1.74 [95% CI, 0.36-3.12], P = 0.01) and CAL ≥6 mm (osteoporosis = 5.07 [95% CI, 2.74-7.40], P < 0.001). This systematic review and meta-analysis indicates that postmenopausal women with osteoporosis or osteopenia may exhibit greater CAL compared with women with normal BMD.
authors.affiliation: 1 Department of Preventive Dentistry, Odontoclínica Central da Marinha, Rio de Janeiro, Brazil.|2 Department of Dental Clinic, Division of Periodontics, Dental School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: D C
authors.initials: DC
authors.lastname: Penoni
authors.affiliation: 3 Department of Community and Preventive Dentistry, School of Dentistry, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: T K S
authors.initials: TK
authors.lastname: Fidalgo
authors.affiliation: 4 Department of Oral Pathology and Diagnosis, Dental School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: S R
authors.initials: SR
authors.lastname: Torres
authors.affiliation: 2 Department of Dental Clinic, Division of Periodontics, Dental School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: V M
authors.initials: VM
authors.lastname: Varela
authors.affiliation: 5 Central Library of the Health Science Center, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: D
authors.initials: D
authors.lastname: Masterson
authors.affiliation: 2 Department of Dental Clinic, Division of Periodontics, Dental School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: A T T
authors.initials: AT
authors.lastname: Leão
authors.affiliation: 6 Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: L C
authors.initials: LC
authors.lastname: Maia
mesh_terms: D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000150:complications*; D005260:Female; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000150:complications*; D017622:Periodontal Attachment Loss / Q000209:etiology*; D012307:Risk Factors
keywords: bone mineral density; osteopenia; osteoporosis; periodontal attachment loss; periodontal disease; women health service