Bone metabolism biomarkers tied to severity of periodontal disease

By Lorraine L Janeczko

NEW YORK (Reuters Health) - A distinct set of bone metabolism biomarkers appears to be associated with more severe periodontal disease, new research suggests.

Researchers found older men with more severe periodontitis had significantly higher levels of parathyroid hormone (PTH) and lower vitamin D levels.

Meanwhile, improvement was linked with lower levels of carboxy-terminal collagen crosslinks (CTX), alpha-CTX and beta-CTX at baseline after adjusting for age, site and body mass index, the team reports in The Journal of Clinical Endocrinology & Metabolism, online April 9.

"Over recent years, interest has increasingly focused on systemic conditions associated with the occurrence and progression of periodontal disease," said lead author Dr. Ulrike Schulze-Spate from the College of Dental Medicine of Columbia University in New York City.

"This does not mean that they lead to periodontal disease but that patients might be more susceptible to developing periodontal disease when a bacterial insult occurs," she told Reuters Health by email.

Dr. Schulze-Spate and her colleagues conducted an ancillary study in 1,347 of the nearly 6,000 men recruited in the Osteoporotic Fractures in Men study. At two of the six study sites, men 65 years and older underwent clinical evaluation, provided information about their medical and dental history and were examined for missing teeth, implants and periodontal disease.

The men had complete periodontal exams, and the diagnosis of periodontitis was based on clinical attachment loss (CAL), pocket depth, calculus, plaque and bleeding on a random half-mouth.

Overall, 829 men returned for a second exam about two to four years later.

At the first dental visit, 13.7% of participants were in the "healthy/gingivitis" category, 38.7% had "mild" periodontitis, 18.3% had "moderate" periodontitis, 18.3% had "severe" periodontitis, and 10.9% had no teeth.

Men who didn't attend college and those who didn't exercise were significantly more likely to have periodontitis. On average, those with worse disease were older and heavier, were more likely to be smokers and non-Caucasian, and were less likely to floss and to visit the dentist.

Men with healthy gums or gingivitis had a mean 25(OH)D level of 23.5 ng/ml and a total intact PTH level of 28.2 pg/ml. In those with severe disease the levels were 22.4 ng/ml and 32.5 pg/ml, respectively, compared to 21.2 ng/ml and 34.4 pg/ml in the toothless (p for trend, 0.001 and 0.0004, respectively).

"At the initial dental visit, men with more severe periodontitis had lower levels of vitamin D and higher levels of PTH; but these measures were not associated with progression," the researchers write. "On the other hand, markers of bone metabolism were not related to the severity of periodontitis cross-sectionally, but men who had improvement in periodontitis had lower levels of bone remodeling markers at baseline than those who remained stable or progressed."

Dr. Schulze-Spate noted that the study was limited by a lack of information about whether subjects received periodontal treatment after they first visited the dentist.

"However, we assume that periodontal disease progression was not due to an intervention because the majority of the subjects either remained within their disease category or progressed to a more severe one," she said. "Overall, our study shows only associations, and additional studies should be performed to expand on our findings."

Dr. P. Mark Bartold, director of the Colgate Australian Clinical Dental Research Centre at the University of Adelaide, Australia, cautioned in an email to Reuters Health that it is unclear "in which groups the spontaneous periodontal improvements occurred."

Dr. Bartold, who was not involved in the study, also noted that the "conclusions are based on a very small sample size of 11 (improved), 61 (deteriorated) and 69 (stable) individuals in each of the transition groups."

SOURCE: http://bit.ly/1GZePaP

J Clin Endocrinol Metab 2015.

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