J Clin Periodontol 2002: 29: 796–802 Copyright C Blackwell Munksgaard 2002

Printed in Denmark . All rights reserved

0303-6979

Assessment of periodontal R. E. Persson, L. G. Hollender,

L. V. Powell, M. I. MacEntee,
C. C. L. Wyatt, H. A. Kiyak and

conditions and systemic disease G. R. Persson

1
Department of Oral Medicine, 2Department
of Oral Maxillofacial Surgery and the Institute

in older subjects on Aging, and 3Department of Periodontics,

University of Washington, Seattle, WA,
4
Private practice, Ukia, CA, USA, 5Division of
Prosthodontics, University of British Columbia.
I. Focus on osteoporosis Vancouver B.C., Canada

Persson RE, Hollender LG, Powell LV, MacEntee MI, Wyatt CCL, Kiyak HA,
Persson GR: Assessment of periodontal conditions and systemic disease in older
subjects. I. Focus on osteoporosis. J Clin Periodontol 2002; 29: 796–802.
CBlackwell Munksgaard, 2002.

Abstract
Background: Osteoporosis (OPOR) is a common chronic disease, especially in
older women. Patients are often unaware of the condition until they experience
bone fractures. Studies have suggested that OPOR and periodontitis are associ-
ated diseases and exaggerated by cytokine activity. Panoramic radiography
(PMX) allows studies of mandibular cortical index (MCI), which is potentially
diagnostic for OPOR.
Aims: i) To study the prevalence of self-reported history of OPOR in an older,
ethnically diverse population, ii) to assess the agreement between PMX/MCI find-
ings and self-reported OPOR, and iii) to assess the likelihood of having both a
self-reported history of OPOR and a diagnosis of periodontitis.
Materials and methods: PMX and medical history were obtained from 1084 sub-
jects aged 60–75 (mean age 67.6, SD ∫ 4.7). Of the films, 90.3% were useful for
analysis. PMXs were studied using MCI. The PMXs were used to grade subjects
as not having periodontitis or with one of three grades of periodontitis severity.
Results: A positive MCI was found in 38.9% of the subjects, in contrast to 8.2%
self-reported OPOR. The intraclass correlation between MCI and self-reported
OPOR was 0.20 (P ⬍ 0.01). The likelihood of an association between OPOR and
MCI was 2.6 (95%CI: 1.6, 4.1, P ⬍ 0.001). Subjects with self-reported OPOR
and a positive MCI had worse periodontal conditions (P ⬍ 0.01). The Mantel-
Haentzel odds ratio for OPOR and periodontitis was 1.8 (95%CI: 1.2, 2.5, P ⬍
0.001).
Conclusions: The prevalence of positive MCI was high and consistent with epide-
miological studies, but only partly consistent with a self-reported history of osteo-
porosis with a higher prevalence of positive MCI in Chinese women. Horizontal Key words: ethnicity; older; osteoporosis;
alveolar bone loss is associated with both positive self-reported OPOR and panoramic radiograph; periodontitis
MCI. Accepted for publication 27 August 2001

Although the average lifespan in most counted for nearly a quarter of all diabetes, suicide, kidney, and chronic
western societies is increasing, both sys- deaths, whereas recently the leading liver disease (Guyer et al. 2000).
temic and oral health deteriorate with causes of death in adults 45 and older Osteoporosis is a degenerative disease
aging. Concurrently, the leading cause in the United States were heart disease, that affects approximately 20 million
of death has shifted from infectious to cancer, stroke, chronic obstructive pul- people in the United States and causes
chronic diseases. In the early 20th cen- monary disease, accidents (uninten- approximately 2 million fractures each
tury, infectious respiratory diseases ac- tional injuries), pneumonia, influenza, year (National Institute of Arthritis and
 Panoramic radiography, periodontitis and osteoporosis 797

Skin diseases 2000). Studies have shown tory of osteoporotic fractures also tend dominantly European descendants,
that mandibular bone mass is corre- to have increased resorption and thin- Chinese, African-American, and His-
lated with skeletal bone mass (Kribbs ning of the mandibular lower cortex panic in Seattle; European descendants,
et al. 1983; 1984; Von Wowern et al. (Bollen et al. 2000). However, other Chinese and East Indians in Vancouver)
1994). Postmenopausal women who do studies have failed to demonstrate as- between the ages of 60 and 75 years with
not use hormone replacement therapy sociations between periodontal status at least four natural teeth were recruited
exhibit a strong negative correlation be- and the early stage of osteopenia, and (Kiyak et al. 2000). Efforts were made
tween the number of teeth retained and osteporosis (Mohajery & Brooks 1992, to enroll a regionally representative eth-
the time since menopause (Becker et al. Hildebolt et al. 1997). nic distribution of subjects. Each sub-
1997). Older women taking hormone The 1992 US National Institute of ject was asked to complete a compre-
replacement therapy appear to have Health Workshop on osteoporosis and hensive health questionnaire and to
better periodontal health than women oral bone loss recommended popula- provide a list of medications and their
not on therapy (Persson et al. 1998, tion-based studies of the association be- dosages. In the event a subject could
Payne et al. 1999). tween osteoporosis and oral conditions not provide such lists, contacts were
Several factors have been associated (McGowan & Redford 1993). Thus, made with their physicians to collect the
with osteoporosis, including female larger cross-sectional and longitudinal information. Medication data were ob-
gender, age, ethnicity, diet, and smok- studies are needed. The objectives of the tained directly from the containers
ing. Routine medical methods to diag- present study were: brought in by participants. For the non-
nose subjects with osteopenia, an early English-speaking subjects, the health
stage of osteoporosis, and osteoporosis O to study the prevalence of osteo- questionnaire was translated using a
include single photon absorptiometry, penia/osteoporosis as defined by self- double translation process. All inter-
dual energy X-ray absorption , and report in an older, ethnically diverse views with non-English speaking sub-
quantitative computed tomography. population; jects were conducted in their native lan-
PMS methods to study bone density O to determine to what extent such guages by a translator who was a native
and anatomy associated with osteporot- findings agreed with panoramic speaker of each language.
ic changes have been published radiographic findings of cortical At the University of Washington the
(Southard et al. 1992, Klemetti et al. bone changes suggesting osteopor- PMXs were taken at the Division of
1993, 1994a, Taguchi et al. 1995a, Boll- osis; Oral Radiology, Department of Oral
en et al. 2000). O to test whether panoramic signs or Medicine, using an Orthophos Plus
Studies have also found that spinal self-reported history of osteoporosis (Siemens AG, Bensheim, Germany),
fractures in older women are associated are associated with a diagnosis of whereas the PMXs in Vancouver were
with fewer remaining teeth and peri- periodontitis. taken at community dental practices or
odontitis, suggesting that periodontitis the Dental School at the University of
may be aggravated in subjects with os- British Columbia using different equip-
teoporosis (Taguchi et al. 1995a,1995b, ment (i.e. Planmeca, Panalipse, Or-
Material and methods
Birkenfeld et al. 1999). Other cross-sec- thophos, Helsinki, Finland). Two exam-
tional studies suggest an association be- The present study was approved by the iners (L.G.H. and R.E.P.) jointly ana-
tween systemic osteoporosis and peri- institutional Review Boards (IRBs) at lyzed and reached consensus agreement
odontal status in postmenopausal non- the University of Washington and the on all PMX films. The mandibular cor-
Hispanic white women (Mohammad University of British Columbia. A total tex index (MCI) was assigned as appro-
et al. 1996, Wactawski-Wende et al. of 1101 subjects from the Seattle and priate for the cortical area below the
1996). Subjects with a self-reported his- Vancouver metropolitan areas (pre- mandibular foramen. (Klemetti et al.
1994b, Jowitt et al. 1999). Briefly, the
mandibular cortex on a panoramic
radiograph was classified as ‘0’ or nor-
Table 1. Subject demographic characteristics
mal (even and sharp endosteal margin),
Seattle Vancouver Combined ‘1’ moderately eroded (evidence of la-
Variable n Ω 701 n Ω 383 n Ω 1084 cunar resorption or endosteal cortical
Gender residues), or ‘2’ severely eroded (un-
Male 40.5 % 57.0 % 46.3 % equivocal porosity).
Female 59.5 % 43.0 % 53.7 % The frequencies of mesial and distal
Ethnicity vertical bone defects ⱖ3 mm around re-
Caucasian 48.0 % 46.7 % 47.6 % maining teeth along with the number of
Chinese 35.8 % 18.2 % 29.7 %
molars showing an identifiable interrad-
East Indian 0.0 % 29.9 % 10.4 %
African American 10.7 % 1.6 % 7.6 %
icular marginal radiolucency were
Other 5.5 % 3.6 % 4.7 % counted. The extent of alveolar (hori-
Smoking status zontal) bone height was assessed using
Current smoker 7.9 % 4.8 % 7.5 % a composite periodontal index (0–3),
Quit smoker 31.2 % 34.3 % 32.0 % where a score of ‘0’ was assigned when
Never smoker 60.9 % 59.2 % 60.5 % there was no sign of horizontal bone
Age (mean ∫ SD) 67.1 ∫ 4.7 67.0 ∫ 4.9 67.1 ∫ 4.7 loss or interradicular radiolucency; a
Remaining teeth 21.7 ∫ 6.8 22.4 ∫ 6.3 22.0 ∫ 6.6 score of ‘1’ if the extent of overall bone
(mean ∫ SD)
loss was less than 25%, a score of ‘2’ if
798 Persson et al.

the extent of bone loss varied between Table 2. Self-reported osteoporosis, osteoarthritis, chronic pain, and MCI scores
25 and 50%, and a score of ‘3’ if the Variable Seattle Vancouver Combined
overall extent of bone loss exceeded
Self-report
50% of the root length. To assess the Osteoporosis 7.9 % 8.8 % 8.2 %
odds ratio of association between a self- Osteoarthritis 38.7 % 28.3 % 35.0 %
reported history of osteopenia/ostep- Chronic pain 17.7 % 8.8 % 14.6 %
orosis and periodontitis, only subjects Self-report osteoporosis by ethnicity
who scored ‘0’ on the radiographic as- Caucasian 7.8 % 7.6 % 7.8%
sessment were identified as peri- Chinese 9.2 % 20.9 % 11.7 %
odontally normal. All others were iden- African American 4.0 % 3.7 % 3.9 %
tified as subjects with periodontitis East Indian
MCI
(composite PMX index).
All subjects 40.8 % 34.2 % 38.9 %
Females 51.9 % 54.0 % 49.1 %
Data analysis

Descriptive statistics were used to pres-

ent information about the prevalence of teoporosis were found by ethnicity (P ⬍ ⬍ 0.0001). Significant correlations
systemic diseases and PMX findings. 0.02, n-par Kruskal–Wallis ). emerged between a self-reported history
The Mantel–Haenszel (common odds Thus, the Chinese participants more fre- of osteoporosis and osteoarthritis (r Ω
ratio) estimate was used to measure quently reported a history of osteopor- 0.36, P ⬍ 0.001, Spearman rank corre-
agreements between the periodontal di- osis than did the Caucasians (P ⬍ 0.05) lation test) and between osteporosis and
agnosis and self-reported osteoporosis or African Americans (P ⬍ 0.03). Al- chronic pain (r Ω 0.20, P ⬍ 0.001, Spear-
status.  (both independent para- though not clinically relevant, subjects man rank correlation test). The com-
metric and nonparametric tests) was who reported a history of osteoporosis mon odds ratio (Mantel–Haentzel) for
used to assess differences by ethnicity had significantly fewer teeth than those an agreement between self-reported os-
and gender. Correlation coefficients who did not report this condition (mean teoporosis and osteoarthritis was 4.2
were defined by Spearman rank corre- values 20.2 versus 22.1 respectively, t Ω (95%CI 2.2, 6.8, P ⬍ 0.001), and be-
lation. Data were analyzed with the 1.4, P ⬍ 0.01). In women the correlation tween osteoporosis and chronic pain 3.2
SPSS statistical package 10.0 (Chicago, between the use of hormonal replace- (95%CI: 2.0, 5.3, P ⬍ 0.001).
IL, USA). ment therapy and a self-reported history
of osteoporosis was significant (rΩ0.16,
PMX findings
P ⬍ 0.01). HRT was prescribed to 68% of
Results Caucasian women, 22.1% of African The PMX films allowed assessment of
Sample characteristics (Table 1) American women, but none of the Chi- the mandibular cortex in 90.3% of the
nese women were using HRT. films (99.6% for Seattle, and 74.3% for
Sample characteristics were, in general, Seattle subjects reported a higher fre- Vancouver). The intraclass correlation
similar between Seattle and Vancouver quency of chronic pain than did their between MCI and self-reported diag-
and consistent with area characteristics. counterparts in Vancouver (c2 Ω 40.6, P nosis of osteoporosis was only 0.20
Proportionally more women were en-
rolled at the Seattle study site (c2 Ω
35.7, P ⬍ 0.0001). No statistically sig-
nificant differences between the Seattle
and Vancouver cohorts were found for
the following variables: age, number of
remaining teeth, or smoking status.
Panoramic radiographs were available
for analysis from 1084 of the originally
1101 enrolled subjects.

Self-reported osteoporosis, osteoarthritis

and chronic pain (Table 2)

Osteoporosis was reported by 8.2 % of

the subjects. Significantly more women
reported a history of osteoporosis
(women 13.1 %, men 2.2% (c2 Ω 40.2, P
⬍ 0.0001) and consistent with general
perceptions of disease distribution by
gender. No differences in the reported
history of osteoporosis were found be-
tween Seattle and Vancouver subjects.
Overall significant differences in the dis- Fig. 1. ROC curve demonstrating the MCI test characteristics using self-reported history of
tribution of self-reported history of os- osteoporosis as the gold standard.
 Panoramic radiography, periodontitis and osteoporosis 799

(95%CI: 0.10, 0.30), but it was statisti- ences, however, were found for overall fined by a composite alveolar bone index
cally significant (P ⬍ 0.01). PMX find- horizontal bone loss or furcation in- are associated.
ings by MCI suggesting osteoporosis vasions. The composite PMX peri-
were found in 38.9% of the subjects odontal score also demonstrated that
Discussion
(MCI score ⱖ1). If the MCI cutoff was the Chinese subjects had a significantly
set at a score ⱖ2, only 11.0% of the higher prevalence of periodontitis than The reproducibility of bone mineral
subjects would have had a positive MCI the Caucasians (P ⬍ 0.001 Mann–Whit- density measurements by dual energy
score. Using the MCI cutoff point ⱖ1 ney U-test). X-ray absorptiometry commonly used
the sensitivity of the MCI score to When the data were specifically ana- to determine whether a subject has os-
identify self-reported osteoporosis was lyzed for women only, the association teporosis or not has limitations (Philli-
0.61, with a specificity of 0.67. Al- between self-reported osteoporosis and pov & Phillips 2001). Therefore, a diag-
though the predictive value positive was radiographic evidence of periodontitis nosis of osteoporosis and especially its
low (12.7%) the predictive value nega- (composite PMX index) was significant, earlier stages may be difficult. As a re-
tive was high (94.6%). The common with a common odds ratio of 1.8 sult, many older people may have osteo-
odds of an association between the (95%CI: 1.2, 2.5, P ⬍ 0.001). These find- porosis without knowing it. Older
MCI 0/ⱖ 1 score and self-reported his- ings were confirmed by non-parametric adults often present with significant
tory of osteoporosis (0/1) was 2.6 analysis using the Mann–Whitney U- horizontal alveolar bone loss, and may
(95%CI: 1.6, 4.1, P ⬍ 0.001). The ROC test, demonstrating that the distribution therefore benefit from also being screen-
(receiver operator characteristic curve) of horizontal alveolar bone loss as de- ed for osteoporosis. Medication to pre-
illustrates the performance of the MCI fined by the composite periodontal vent or limit the effects of osteoporosis
to identify subjects with or without a PMX index was significantly higher in with drugs containing biphosphonate
self-reported history of osteoporosis subjects with a positive MCI (cutoff ⱖ1) affects prostaglandin E2 production,
(Fig. 1). (P ⬍ 0.01). No differences in prevalence and may also help reduce progressive
Periodontal characteristics are pre- or vertical alveolar bone defects were alveolar bone loss.
sented in Table 3. Approximately half found. The distribution of horizontal PGE2 upregulates osteoclast activity,
(48.5%) of the subjects had evidence of bone loss scores (composite by MCI and especially, in cases of estrogen de-
alveolar bone loss. Periodontal findings self-reported osteoporosis are presented ficiency (Kanematsu et al. 2000).
among the four major ethnic groups are in Fig. 2 (A and B). Women using HRT Osteoporosis is influenced by the
presented in Table 2. Analysis by  had significantly fewer PMX signs of socioeconomic status of older women
(Post-Hoc Bonferroni test) demon- horizontal alveolar bone loss (P ⬍ 0.05, (Varenna et al. 1999). Self-reports from
strated significant ethnic differences, Mann–Whitney U-test). Thus, the data subjects in a Swedish study, based on
such that the Chinese population had support the hypothesis that self-reported diagnostic criteria from the NHANES
significantly more teeth with vertical de- osteoporosis and assessments of cortical III in the USA, reveal that the preva-
fects than the Caucasians (F Ω 3.0, P ⬍ bone changes from PMX and the pres- lence of osteoporosis approaches 22%
0.02). Neither ethnic nor gender differ- ence and severity of periodontitis as de- in women and 6.3% in men between

Table 3. Percent distribution of vertical defects, horizontal bone loss scores, furcation defects, and composite PMX periodontal index based
on assessments from panoramic radiographs and the three largest ethnic groups at the Seattle and Vancouver study sites with the all subject
category representing all nine ethnic groups studied
Seattle study site

Vertical defects Horizontal bone loss Furcation Composite PMX

(%) score (%) defects (%) Periodontal Index

0 1–3 ⱖ4 0 1 2 3 0 1π 0 1
Ethnicity
Caucasian 74.7 22.4 2.9 52.4 32.7 8.9 5.1 77.3 22.7 52.7 47.3
Chinese 57.6 38.6 3.8 44.2 40.0 12.0 5.6 52.0 48.0 42.6 57.4
African American 58.4 37.7 3.9 49.4 35.1 11.7 3.9 79.2 20.8 49.4 50.6
All subjects 67.8 29.5 2.7 48.8 35.5 10.4 4.8 68.6 31.4 49.0 51.0
Vancouver study site

Vertical defects Horizontal bone loss Furcation Composite PMX

(%) score (%) defects (%) Periodontal Index

0 1–3 ⱖ4 0 1 2 3 0 1π 0 1
Ethnicity
Caucasian 66.7 21.7 1.6 64.9 26.0 7.6 1.5 74.0 26.0 64.9 35.1
Chinese 65.3 28.6 6.1 38.0 50.0 10.0 2.0 60.7 29.3 38.0 62.0
East Indian 62.2 33.4 4.4 60.7 31.5 6.7 1.1 63.3 36.7 60.7 39.3
All subjects 67.6 32.6 3.8 56.8 32.1 7.8 2.4 66.0 34.0 57.7 42.3
800 Persson et al.

in Chinese women. The study also

demonstrated an association between
osteoporosis and periodontitis.

Acknowledgment
We appreciate the support of Carol Ho-
eller, Karen Manary, Judy Laird, and
student helpers on the T.E.E.T.H. study,
Oral Radiology clinic, and staff mem-
bers of the RCDRC. The present study
was funded by the NIH/NIDCR grant
Fig. 2. Distribution of composite periodontal index scores (A) by positive or negative MCI
status and (B) by positive or negative self-reported osteoporosis status.
RO1 DE 12215 and by the Regional
Clinical Dental Research Center
NIDCR grant P30 DEO9743.

Zusammenfassung
the ages of 50 and 84 years (Kanis or a stroke is accurate (Psaty et al.
et al. 2000). Our panoramic evaluation 1995). Nevertheless, others have dem- Bestimmung parodontaler Bedingungen und
of the mandibular cortex identified os- onstrated that a self-administered systemischer Erkrankungen bei älteren Pati-
teporosis/osteopenia in 52.4% of the questionnaire can assess accurately the enten. I. Fokus auf Osteoporose
Hintergründe: Osteoporose (OPOR) ist eine
women, or approximately 2.5 times the prevalence of stroke in epidemiological
häufig, insbesondere bei älteren Frauen auf-
prevalence rate reported by Kanis research (Engstad et al. 2000). tretende chronische Erkrankung. Patienten
et al. (2000), and four times the rate In the present study a relatively high sind sich oft nicht der Anwesenheit der Er-
obtained from the self-reports of our proportion of Caucasian women used krankung bewusst, bis Knochenbrüche auf-
subjects. Studies using dual X-ray ab- HRT, which is the most commonly treten. Studien legen den Schluss nahe, dass
sorptiometry suggest that osteoporosis prescribed drug to prevent osteopor- OPOR und Parodontitis verwandte Krank-
can be diagnosed in 49–72% of women osis. In the present study, a large pro- heiten sind, und durch die Aktivitäten von
at the age of 70 (Löfman et al. 2000). portion of Caucasian women with a Zytokinen verschärft werden. Panorama-
Assessment of mandibular cortical self-report or PMX evidence of osteo- Röntgenaufnahmen (PMX; panoramic ra-
diography) gestatten Untersuchungen des
bone changes (MCI) might be more porosis used HRT. However, no Chi-
Rindenknochens (MCI; mandibular cortical
accurate than self-reports from the el- nese subjects used HRT despite a bone), die für OPOR potentiell von diagno-
dery who have the disorder but have higher prevalence of osteoporosis in stischem Wert sind.
not been diagnosed. A majority of the this group. This seems to be consistent Zielsetzung: Ziel der vorliegenden Studie ist
subjects in the present study came with the present finding of a higher (1) die Untersuchung der Prävalenz einer
from low-income backgrounds and prevalence of both self-reported and selbst berichteten OPOR-Anamnese bei einer
may not have had access to medical di- PMX identified signs of osteoporosis älteren, ethnisch vielschichtigen Population,
agnosis and care/prevention of osteo- in Chinese women. The fact that (2) die Bestimmung der Übereinstimmung
porosis. The fact that especially Chi- chronic pain was reported more fre- zwischen PMX / MCI-Ergebnissen und einer
selbst berichteten OPOR, und (3) die Bestim-
nese women in the present study ex- quently among women is suggestive of
mung der Wahrscheinlichkeit einer selbst be-
pressed signs of osteoporosis and did osteoporosis, as chronic pain often is richteten OPOR und einer Diagnose auf Pa-
not use HRT suggests that they had present in subjects with osteoporosis rodontitis.
not been examined and would not (Malmros et al. 1998). In previous Material und Methodik: Von 1084 Patienten
have known if they had osteoporosis studies, HRT has been associated with im Alter von 60 – 75 Jahren (durchschnitt-
or not. better periodontal status and a de- liches Alter 67,7, SA ∫ 4,7 Jahre) wurden
Good dental practice requires that creased risk for tooth loss (Persson PMX angefertigt und eine medizinische An-
the dentist collects and reviews a pa- et al. 1998). Therefore the use of HRT amnese erstellt. 90,3% der Röntgenaufnah-
tient’s medical history, most commonly may have confounded the present re- men waren für die Analyse von Wert. Die
PMX wurden durch MCI (Beschreibung
self-reported by the patient. Ideally, a sults. However, the only two factors
durch Klemetti et al., 1994) untersucht. Die
professional medical history should be statistically identified as associated PMX wurden verwendet, um Patienten als
obtained for all dental and research with osteoporosis were gender and eth- mit Parodontitis oder mit einem von drei
patients. In the present study, infor- nicity. Schweregraden der Erkrankung einzuteilen.
mation about medications was col- In conclusion, the present study de- Ergebnisse: Im Gegensatz zu 8,2% der selbst
lected and confirmed as necessary by monstrated that the prevalence of signs berichteten OPOR wurde bei 38,9 % der Pa-
the prescribing physician. This pro- of osteoporosis from PMX using the tienten ein positiver MCI beobachtet. Die
cedure provided a mechanism by MCI as described by Klemetti et al. Korrelation innerhalb der Klassen zwischen
which the investigators could confirm (1994a) is high and consistent with epi- MCI und selbst berichtetem OPOR lag bei
0,20 (p ⬍ 0.01). Die Wahrscheinlichkeit einer
the self-reported history given by sub- demiological studies. The association
Beziehung zwischen OPOR und MCI lag bei
jects. Patients seeking dental care may between MCI and self-reported history 2,6 (95 % CI: 1,6, 1,6, 4,1, p ⬍ 0,001). Bei
or may not be particularly aware of of osteoporosis is low, although the Patienten mit einem selbst berichteten
their general health (Thompson et al. predictive value negative is high. The OPOR, bestätigt durch MCI, wurde ein
1999). Approximately 75% of a self-re- study demonstrated a higher preva- schlechterer parodontaler Zustand beobach-
ported history of a myocardial infarct lence of positive MCI signs on PMX tet (p ⬍ 0.01). Die Odds Ratio nach Mantel-
 Panoramic radiography, periodontitis and osteoporosis 801

Haentzel für OPOR und Parodontitis lag bei risk factors in female dental patients. A the osteoporosis risk group. Scandinavian
1,8 (95% CI: 1,2, 2,5, p ⬍ 0.001). preliminary report. Journal of Indiana Journal of Dental Research 102, 68–72.
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ten OPOR in Beziehung. mandibular cortical bone. Oral Surgery, Prosthetic Dentistry 50, 719–724.
Oral Medicine, Oral Pathology, Oral Radi- Löfman, O., Larsson, L. & Toss, G. (2000)
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la maladie systémique chez les sujets âgés
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Yokoyama-Crothers, N., Muckerman, J., McGowan, J. & Redford, M. (1993) Proceed-
dies associées et exacerbées par l’activité de
Hauser, J., Cohen, S., Kardaris, E., Vann- ings from the workshop on osteoporosis
la cytokine. La radiographie panoramique
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cette étude ont été 1) de calculer la fréquence
Jowitt, N., MacFarlane, T., Devlin, H., Kle- Mohajery, M. & Brooks, S. L. (1992) Oral
globlale d’OPOR rapportée par les individus
metti, E. & Horner, K. (1999) The repro- radiographs in the detection of early signs
d’une population d’ethnies diverses, 2) d’éva-
ducibility of the mandibular cortical of osteoporosis. Oral Surgery, Oral Medi-
luer l’accord entre les découvertes PMX/MCI
index. Dentomaxillofacial Radiology 28, cine, and Oral Pathology 73, 112–117.
et l’OPOR déclarée, 3) de comparer l’OPOR
141–144. Mohammad, A. R., Brunsvold, M. & Bauer,
déclarée au diagnostic de parodontite. La
Kanematsu, M., Sato, T., Takai, H., Watana-
PMX et le passé médical ont été obtenus de R. (1996) The strength of association be-
be, K., Ikeda, K. & Yamada, Y. (2000)
1 084 patients de 60 à 75 ans (moyenne tween systemic postmenopausal osteopor-
Prostaglandin E2 induces expression of re-
67,6∫4,7). 90,3% des films ont pu être utilisés osis and periodontal disease. International
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pour l’analyse. Les PMX ont été étudiés en Journal of Prosthodontics 9, 479–483.
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Un MCI positif a été trouvé chez 38,9 % des oporotic/osteopenic women. Osteoporosis
15, 1321–1329.
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Kanis, J. A., Johnell, O., Oden, A., De Jons-
tion intraclasse entre MCI et OPOR déclarée Persson, R. E., Persson, G. R., Kiyak, H.
son, B., Laet, C. & Dawson, A. (2000)
par le patient était de 0,20 (p⬍0,01). La pro- A. & Powell, L. V. (1998) Oral health and
Risk of hip fracture according to the
babilité d’une association entre OPOR et medical status in dentate low-income older
World Health Organization criteria for
MCI était de 2,6 (95%CI: 1,6, 4,1, p⬍0,001). persons. Special Care in Dentistry 18, 70–
osteopenia and osteoporosis. Bone 27,
Les patients qui avaient une OPOR déclarée 77.
585–590.
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Hujoel, P. P., Persson, G. R., Wyatt, C. &
risque Mantel-Haentzel pour l’OPOR et la women and men. Osteoporosis Interna-
MacEntee, M. I. (2000) The Teeth Colla-
parodontite étaient de 1,8 (95%CI: 1,2, 2,5 tional 12, 362–365.
borative group. The trial to enhance elder’s
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tooth and oral health (TEETH study).
sitif était importante et semblable à celle G. L., Kittner, S. J., Mittelmark, M., Price,
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Klemetti, E., Collin, H. L., Forss, H., Mark-
l’histoire d’ostéoporose déclarée par le pa- diovascular disease in the Cardiovascular
kanen, H. & Lassila, V. (1994a) Mineral
tient lui-même; Cette fréquence globale était Health Study. Annuals of Epidemiology 5,
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