Influence of estrogen and osteogenia/osteoporosis on clinical periodontitis in postmenopausal women

Background: In Western societies, more than one-third of the female populat ion above age 65 suffers from signs and symptoms of osteoporosis, a disorde r characterized by low bone mass. Estrogen deficiency is the dominant patho genic factor for osteoporosis in women. The impact of estrogen deficiency a nd osteopenia/osteoporosis on periodontitis is unclear, partially due to th e lack of longitudinal studies evaluating clinical signs of gingival inflam mation and periodontitis progression. The purpose of this investigation was to analyze prospectively the influence of serum estradiol levels and osteo penia/osteoporosis on common clinical measurements of periodontal disease o ver a 2-year period. Methods: Fifty-nine moderate/advanced adult periodontitis patients and 16 n on-periodontitis subjects, all within 5 years after menopause at baseline, completed the study. Serum estradiol levels (E-2) were measured yearly by I -125 radioimmunoassay, and osteopenia/osteoporosis was determined by dual e nergy x-ray absorptiometry of the lumbar spine. Posterior interproximal cli nical measurements were obtained every 6 months for the periodontitis patie nts, including explorer-detectable supragingival plaque, bleeding on probin g (BOP) and relative clinical attachment level (RCAL). Baseline probing dep ths, smoking history, and demographic data also were collected. Results: Data indicated that baseline demographic measurements and bone min eral density (BMD) of the lumbar spine were not different between E-2-defic ient and E-2-sufficient subjects. Smoking activity (packs smoked/day, years smoked) was higher in periodontitis patients (P=0.0001). E-2-sufficient pe riodontitis subjects had a higher frequency of supragingival plaque without increasing gingival inflammation. E-2 status did not influence the percent age of sites losing RCAL for either periodontitis or non-periodontitis grou ps, but when non-smoking osteopenic/osteoporotic periodontitis patients wer e evaluated, E-2-deficient subjects had more BOP (43.8% versus 24.4%, P<0.0 4) and a trend toward a higher frequency of greater than or equal to 2.0 mm RCAL loss (3.8% versus 1.2%, P<0.1) than E-2-sufficient subjects. Conclusions: These data suggest that E-2 supplementation (serum E-2>40 pg/m l) is associated with reduced gingival inflammation and a reduced frequency of clinical attachment loss in osteopenic/osteoporotic women in early meno pause.