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Relationship between osteoporosis and periodontitis still unclear

Joan Leakey Clinical Associate Professor-Hygiene .


Systematic Review Conclusion

While evidence suggests a relationship between osteoporosis and periodontitis, further studies are required to establish the nature of the relationship.

Critical Summary Assessment

This weak systematic review of observational studies does not provide adequate evidence to help identify patients at risk of osteoporosis based on periodontal findings.

Evidence Quality Rating

Limited Evidence

Structured Abstract

Clinical Questions:

Is there an association between dental bone loss and systemic osteoporosis or osteoporotic fracture?

Review Methods:

The authors searched two databases for studies published between 1966 and 2009. They included studies that examined the relationship between systemic osteoporosis or osteoporotic fractures and alveolar bone loss, periodontitis and tooth loss.

Main Results:

Thirty-five clinical trials (n=5604) were included; 10 used the presence of previous non-traumatic osteoporotic fractures as a diagnostic criterion for osteoporosis and 25 used radiology and absorbtiometry to define systemic osteoporosis. Of the studies focused on the relationship between systemic osteoporosis and mandibular osteoporosis (defined by radiologic alveolar bone loss), 12 of 13 demonstrated a positive association; 4 of 9 were positive for systemic osteoporosis and periodontitis (defined by clinical periodontal findings) and 5 of 7 for systemic osteoporosis and tooth loss. From the included studies, the authors identified fourteen risk factors specifically for osteoporosis, four for periodontitis and five as risk factors common to both conditions.


The majority of studies suggested a relationship between osteoporosis and periodontitis, but further well-controlled studies are needed.

Source of Funding:

Not reported.


Importance and Context:

Osteoporosis and periodontitis affect bone mass and share common risk factors; for these reasons, they may be related. With further studies, the relationship between systemic and oral bone loss may identify whether dentists and hygienists could give an early warning for patients at risk of osteoporosis.

Strengths and Weaknesses of the Systematic Review:

This is a narrative review without a meta-analysis and little description of the included studies. The systematic review did not include number, age, sex or smoking status of subjects from the included studies. The literature search included two databases, but no search of gray literature. There was no duplicate study selection. In addition, the authors did not describe study design, risk of bias assessment or assessment of publication bias.

Strengths and Weaknesses of the Evidence:

Only one study reported the (small) sample size of subjects. Some studies used trabecular pattern, cortical thickness and mandibular bone mass to determine presence of periodontitis. These characteristics are not used as clinical criteria in diagnosing periodontal disease, so their inclusion in assessing the relationship with osteoporosis is misleading. The lack of description of the characteristics of the included studies makes it difficult to comment on the strength of the evidence. However, the nature of the question leads one to assume that the studies are observational in nature. There is a strong potential for confounding bias in these study designs, thus caution must be exercised when applying results of observational studies to clinical decision-making.

Implications for Dental Practice:

Based on a poorly conducted systematic review, the relationship between osteoporosis and periodontitis remains unclear with no real evidence for the clinician to be able to advise patients concerning osteoporosis risk. *Support for this Critical Summary was provided by a grant from the Canadian Institutes of Health Research*

Critical Summary Publication Date:


These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association © 2019