Penoni D C, Fidalgo T K S, Torres S R, Varela V M, Masterson D, Leão A T T, Maia L C
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.
J Dent Res. 2017 Mar;96(3):261-269. doi: 10.1177/0022034516682017. Epub 2017 Jan 3.
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.
骨质疏松症是一种以低骨矿物质密度（BMD）为特征的全身性骨骼疾病，并且一直被认为是牙周病的一个风险因素。本系统评价和荟萃分析的目的是验证绝经后女性牙周附着丧失与低骨密度之间关联的科学证据。按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，截至2016年8月在数据库中对文献进行了系统检索。纳入标准包括比较低骨密度和正常骨密度的绝经后女性之间临床附着丧失（CAL）的研究。使用类似方法、具有较低和较高偏倚风险的研究被汇总到3项不同的荟萃分析中，以比较骨密度正常、患有骨质疏松症和骨质减少症的女性之间的CAL。在第一项荟萃分析中，比较了各组之间的平均CAL。在另外2项荟萃分析中，分别比较了各组中CAL≥4mm和≥6mm部位的平均百分比。从792篇独特的文献中，选择了26篇文章进行定性综合分析。其中11项研究被评估为偏倚风险较低，其中10项研究观察到低骨密度与CAL之间的关联。13篇横断面文章纳入了骨质疏松症的荟萃分析，9篇纳入了骨质减少症的分析。低骨密度女性的平均CAL高于骨密度正常的女性（骨质疏松症=0.34mm[95%置信区间（CI），0.20 - 0.49]，P<0.001；骨质减少症=0.07mm[95%CI，0.01 - 0.13]，P = 0.02）。只有偏倚风险较低的研究可用于分析CAL的严重程度。低骨密度女性表现出更严重的附着丧失，表现为CAL≥4mm部位的平均百分比（骨质疏松症=3.04[95%CI，1.23 - 4.85]，P = 0.001；骨质减少症=1.74[95%CI，0.36 - 3.12]，P = 0.01）和CAL≥6mm部位的平均百分比（骨质疏松症=5.07[95%CI，2.74 - 7.40]，P<0.001）。本系统评价和荟萃分析表明，与骨密度正常的女性相比，患有骨质疏松症或骨质减少症的绝经后女性可能表现出更大的CAL。
