Comparative assessment of bone mineral density levels in type 2 diabetic subjects with or without chronic periodontitis: A cross-sectional study
Background. This cross-sectional study investigated the bone mineral density (BMD) in type 2 diabetes mellitus (T2DM) subjects with or without chronic periodontitis (CP). Methods. A total of 120 subjects aged 35‒55, divided equally into four groups: i) T2DM with CP, ii) T2DM without CP, iii) CP alon...
Saved in:
Published in | Journal of advanced periodontology and implant dentistry Vol. 13; no. 1; pp. 28 - 34 |
---|---|
Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
Tabriz
Tabriz University of Medical Sciences
2021
|
Subjects | |
Online Access | Get full text |
Cover
Loading…
Abstract | Background. This cross-sectional study investigated the bone mineral density (BMD) in type 2 diabetes mellitus (T2DM) subjects with or without chronic periodontitis (CP). Methods. A total of 120 subjects aged 35‒55, divided equally into four groups: i) T2DM with CP, ii) T2DM without CP, iii) CP alone, and iv) healthy patients, were included in this study. Clinical parameters like plaque index (PI), gingival index (GI), and probing pocket depth (PPD) were recorded. All the participants were evaluated for blood sugar levels using glycated hemoglobin (HbA1c) and BMD by Hologic dual-energy x-ray absorptiometry (DEXA) scan. The association of BMD with clinical periodontal parameters and HbA1c in all groups was investigated using linear correlation analysis (r). Results. The mean value of BMD (0.9020±0.0952 g/cm2) was lower in subjects with both T2DM and CP compared to T2DM and CP alone. BMD was weakly correlated with all the clinical periodontal parameters; a positive correlation was observed between BMD and GI in the T2DM and CP group (r=0.405, P=0.026) and the CP group (r=0.324, P=0.081). A weak positive correlation was observed in BMD and HbA1c in the T2DM group (r=0.261, P=0.13), T2DM and CP group (r=0.007, P=0.970), with a negative correlation to HbA1c in the CP group (r= -0.134, P=0.479). Conclusions: Diabetes mellitus impacts clinical periodontal status and bone mass, and the effect is accentuated when chronic periodontitis is present. Based on the present study, BMD is associated with T2DM and CP, but a weak correlation was observed between BMD and HbA1c and clinical periodontal parameters. |
---|---|
AbstractList | Background. This cross-sectional study investigated the bone mineral density (BMD) in type 2 diabetes mellitus (T2DM) subjects with or without chronic periodontitis (CP). Methods. A total of 120 subjects aged 35‒55, divided equally into four groups: i) T2DM with CP, ii) T2DM without CP, iii) CP alone, and iv) healthy patients, were included in this study. Clinical parameters like plaque index (PI), gingival index (GI), and probing pocket depth (PPD) were recorded. All the participants were evaluated for blood sugar levels using glycated hemoglobin (HbA1c) and BMD by Hologic dual-energy x-ray absorptiometry (DEXA) scan. The association of BMD with clinical periodontal parameters and HbA1c in all groups was investigated using linear correlation analysis (r). Results. The mean value of BMD (0.9020±0.0952 g/cm2) was lower in subjects with both T2DM and CP compared to T2DM and CP alone. BMD was weakly correlated with all the clinical periodontal parameters; a positive correlation was observed between BMD and GI in the T2DM and CP group (r=0.405, P=0.026) and the CP group (r=0.324, P=0.081). A weak positive correlation was observed in BMD and HbA1c in the T2DM group (r=0.261, P=0.13), T2DM and CP group (r=0.007, P=0.970), with a negative correlation to HbA1c in the CP group (r= -0.134, P=0.479). Conclusions: Diabetes mellitus impacts clinical periodontal status and bone mass, and the effect is accentuated when chronic periodontitis is present. Based on the present study, BMD is associated with T2DM and CP, but a weak correlation was observed between BMD and HbA1c and clinical periodontal parameters. All the participants were evaluated for blood sugar levels using glycated hemoglobin (HbA1c) and BMD by Hologic dual-energy x-ray absorptiometry (DEXA) scan. Introduction Diabetes mellitus (DM) is a type of metabolic disorder characterized by a hyperglycemic state due to defects in insulin secretion, insulin activity, or both.1 Type 1 diabetes mellitus (T1DM) is marked by the destruction of beta (ß) cells, while type 2 diabetes mellitus (T2DM) is associated with insulin resistance coupled with insufficient production of insulin.2 Hyperglycemic condition is followed by altered levels of circulating proteins such as collagens or lipids, which undergo non-enzymatic glycation and oxidation, resulting in advanced glycation end products (AGEs), upregulated activation of the proinflammatory transcription factor, nuclear factor-kappa B (NF-kB), and pro-inflammatory cytokines.3 Enhanced superoxide production by mitochondria and elevated levels of matrix metalloproteinases (MMPs) such as MMP-2 and 9 play an essential role in the pathogenesis of diabetes mellitus and its vascular complications.4,5 It is predicted that by 2025, around 380 million adults worldwide will be affected by diabetes, with a prevalence of 6.4%, which is a major global health concern.6 Chronic periodontitis (CP) is a sub-gingival infection mainly caused by gram-negative bacteria.7,8 There is an abnormal host response against the pathogens, and in its severe form, it is associated with bone loss and the loss of soft tissue attached to the tooth.9,10 Host-derived mediators such as prostaglandin (PG) E-2 along with proinflammatory cytokines such as interleukin (IL)-1, IL-6, and tumor necrosis factor (TNF)-a cause periodontal tissue breakdown, which is accentuated in the presence of diabetes.11 Risk factors associated with chronic periodontitis include cardiovascular diseases, poor glycemic control in patients with T2DM, complicated pregnancy, and osteoporosis.12,13 Among the plausible biological mechanisms that link diabetes and periodontitis is enhanced inflammation; thus, in diabetes mellitus subjects, there is increased production of advanced glycation end products (AGEs), which are accumulated in periodontal tissues.14 These AGEs interact with receptor activators of AGE (RAGE) on cells, such as macrophages, and stimulate the production of MMPs, adhesion molecules, and cytokines such as TNF-a, IL-1, 17, 6, 18, and other pro-inflammatory mediators.15 On the other hand, the systemic inflammatory response in periodontitis is characterized by dysregulated secretion of host-derived mediators of inflammation and tissue breakdown, further enhancing the hyperlipidemic diabetic state. [...]it is likely that upregulated inflammation arises from each condition adversely affects the other.16 All these factors result in local tissue damage, increased breakdown of the periodontal connective tissues, and resorption of alveolar bone, leading to the exacerbation of periodontitis.17 Bone remodeling is a complex process affected by various local and systemic factors.18 Bone formation is affected due to reduced expression of transcription factors that regulate osteoblast differentiation.19 BMD determined by bone turnover is one of the most predictive factors of osteoporotic fracture.20 Several mechanisms have been proposed to explain decreased bone mass in diabetes mellitus and periodontitis, such as disordered insulin secretion, increased levels of inflammatory mediators, and altered vitamin D and calcium levels.13,21 Accumulated AGEs in diabetes mellitus and periodontitis reduce osteoblast activity by the AGE-RAGE pathway and enhance osteoclastogenic activity by upregulating RANKL mRNA and impaired matrix mineralization.22,23 Activation of local immune and inflammatory responses results in increased secretion of cytokines such as interleukin-1 beta (IL-1ß), TNF-a, and IL-6, increased oxidative stress, and disruption of the receptor activator of NF-kB ligand/ osteoprotegerin (RANKL/OPG) axis to favor bone resorption, resulting in reduced bone mineral density.24 The existing literature documents that diabetes mellitus is linked with an increased risk of bone fracture and impaired healing.25 Prolonged inflammation in diabetes mellitus and periodontitis inhibits osteoblast differentiation and promotes osteoclastogenesis by producing lytic enzymes that negatively modulate bone homeostasis, increase bone resorption, and limit normal bone repair processes.26 Extension of periodontal inflammation to adjacent bone and ligament reduces BMD causing alveolar bone resorption.27 Reduced BMD in periodontitis can be linked to altered bone homeostasis due to systemic inflammation, reduced collagen synthesis, or hormone deficiencies such as estrogen or parathyroid hormone.20 Due to decreased insulin secretion, bone formation slows down in T1DM, while in T2DM, bone resorption becomes faster, resulting in decreased BMD and impaired mineralization and bone microarchitecture.25 Diabetic subjects have a higher prevalence ofperiodontitis as it is an established complication of diabetes mellitus. [...]no direct association of BMD in diabetic patients with and without chronic periodontitis has been reported. [...]our study aimed to assess and compare BMD levels in T2DM subjects with or without chronic periodontitis to clarify the effect of systemic conditions on bone health. Exclusion criteria Pregnancy, lactating, early menopause, hormone replacement therapy, history of drug intake that affects BMD (thiazide diuretics, statins, anticoagulants, antiepileptics), diseases influencing bone metabolism (hypo/hyperthyroidism, Cushing syndrome, primary hyperparathyroidism, renal failure, liver disease, inflammatory bowel disease, malabsorption), alcohol consumption, osteoporotic fracture history, scoliosis, history of periodontal treatment within the last six months, surgical periodontal therapy, and antibiotic, anti-inflammatory, immunosuppressive or cytotoxic drug intake within the last three months. This cross-sectional study investigated the bone mineral density (BMD) in type 2 diabetes mellitus (T2DM) subjects with or without chronic periodontitis (CP).BackgroundThis cross-sectional study investigated the bone mineral density (BMD) in type 2 diabetes mellitus (T2DM) subjects with or without chronic periodontitis (CP).A total of 120 subjects aged 35‒55, divided equally into four groups: i) T2DM with CP, ii) T2DM without CP, iii) CP alone, and iv) healthy patients, were included in this study. Clinical parameters like plaque index (PI), gingival index (GI), and probing pocket depth (PPD) were recorded. All the participants were evaluated for blood sugar levels using glycated hemoglobin (HbA1c) and BMD by Hologic dual-energy x-ray absorptiometry (DEXA) scan. The association of BMD with clinical periodontal parameters and HbA1c in all groups was investigated using linear correlation analysis (r).MethodsA total of 120 subjects aged 35‒55, divided equally into four groups: i) T2DM with CP, ii) T2DM without CP, iii) CP alone, and iv) healthy patients, were included in this study. Clinical parameters like plaque index (PI), gingival index (GI), and probing pocket depth (PPD) were recorded. All the participants were evaluated for blood sugar levels using glycated hemoglobin (HbA1c) and BMD by Hologic dual-energy x-ray absorptiometry (DEXA) scan. The association of BMD with clinical periodontal parameters and HbA1c in all groups was investigated using linear correlation analysis (r).The mean value of BMD (0.9020±0.0952 g/cm2) was lower in subjects with both T2DM and CP compared to T2DM and CP alone. BMD was weakly correlated with all the clinical periodontal parameters; a positive correlation was observed between BMD and GI in the T2DM and CP group (r=0.405, P=0.026) and the CP group (r=0.324, P=0.081). A weak positive correlation was observed in BMD and HbA1c in the T2DM group (r=0.261, P=0.13), T2DM and CP group (r=0.007, P=0.970), with a negative correlation to HbA1c in the CP group (r= -0.134, P=0.479).ResultsThe mean value of BMD (0.9020±0.0952 g/cm2) was lower in subjects with both T2DM and CP compared to T2DM and CP alone. BMD was weakly correlated with all the clinical periodontal parameters; a positive correlation was observed between BMD and GI in the T2DM and CP group (r=0.405, P=0.026) and the CP group (r=0.324, P=0.081). A weak positive correlation was observed in BMD and HbA1c in the T2DM group (r=0.261, P=0.13), T2DM and CP group (r=0.007, P=0.970), with a negative correlation to HbA1c in the CP group (r= -0.134, P=0.479).Diabetes mellitus impacts clinical periodontal status and bone mass, and the effect is accentuated when chronic periodontitis is present. Based on the present study, BMD is associated with T2DM and CP, but a weak correlation was observed between BMD and HbA1c and clinical periodontal parameters.ConclusionDiabetes mellitus impacts clinical periodontal status and bone mass, and the effect is accentuated when chronic periodontitis is present. Based on the present study, BMD is associated with T2DM and CP, but a weak correlation was observed between BMD and HbA1c and clinical periodontal parameters. |
Author | Bey, Afshan Ateeq, Hira Zia, Afaf Husain, Qayyum |
AuthorAffiliation | 1 Department of Biochemistry, Faculty of Life Science, Aligarh Muslim University, Aligarh, India 2 Dr Ziauddin Ahmad Dental College, Aligarh Muslim University, Aligarh, India |
AuthorAffiliation_xml | – name: 1 Department of Biochemistry, Faculty of Life Science, Aligarh Muslim University, Aligarh, India – name: 2 Dr Ziauddin Ahmad Dental College, Aligarh Muslim University, Aligarh, India |
Author_xml | – sequence: 1 givenname: Hira orcidid: 0000-0003-3197-9066 surname: Ateeq fullname: Ateeq, Hira organization: Department of Biochemistry, Faculty of Life Science, Aligarh Muslim University, Aligarh, India – sequence: 2 givenname: Afaf orcidid: 0000-0003-2932-4909 surname: Zia fullname: Zia, Afaf organization: Dr Ziauddin Ahmad Dental College, Aligarh Muslim University, Aligarh, India – sequence: 3 givenname: Qayyum orcidid: 0000-0002-0343-5013 surname: Husain fullname: Husain, Qayyum organization: Department of Biochemistry, Faculty of Life Science, Aligarh Muslim University, Aligarh, India – sequence: 4 givenname: Afshan orcidid: 0000-0002-2136-1572 surname: Bey fullname: Bey, Afshan organization: Dr Ziauddin Ahmad Dental College, Aligarh Muslim University, Aligarh, India |
BookMark | eNpdkktv1DAUhSNURB90zdYSGzYz9TNOWCBVIyiVKrGBteXY1x2PEjvYzlTzL_jJmJkKUVbX8v187vXRuWzOQgzQNO8IXjNOJL3Z6dnbNcWUrDHuXjUXtOViJViPz_45nzfXOe8wxrSTQmDxpjlnoid9T9hF82sTp1knXfwekM4Zcp4gFBQdGuo0NPkASY_IQsi-HNAIexgz8gGVwwyIIuv1AMUblJdhB6Zk9OTLFsV0rHEpyGxTDBWYIfloYyi--PwR3SKTYs6rXB_5GOqMXBZ7eNu8dnrMcP1cr5ofXz5_33xdPXy7u9_cPqwMY6xbEU16CY45Mhgx2M44ZwQQ0xqse8tbClp3TAjCW4urE5ZR6bDllDopHJfsqrk_6dqod2pOftLpoKL26ngR06PSqf5rBMUHQY1oXScHwak1HSfWGMzqDEl7rqvWp5PWvAwTWFMNrJ69EH3ZCX6rHuNe9XUr3uMq8OFZIMWfC-SiJp8NjKMOEJesaNvLVrasoxV9_x-6i0uq9lVKCIapbEVbqZsTdfQ4gfu7DMHqGB51DI_6Ex5Vw8N-A-CVu-c |
ContentType | Journal Article |
Copyright | 2021. This work is published under http://dentistry.tbzmed.ac.ir/jpid/index.php/jpid/about/editorialPolicies#openAccessPolicy (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2021 The Author(s). 2021 The Author(s). 2021 |
Copyright_xml | – notice: 2021. This work is published under http://dentistry.tbzmed.ac.ir/jpid/index.php/jpid/about/editorialPolicies#openAccessPolicy (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. – notice: 2021 The Author(s). – notice: 2021 The Author(s). 2021 |
DBID | AAYXX CITATION 3V. 7X7 7XB 8FE 8FH 8FI 8FJ 8FK ABUWG AFKRA AZQEC BBNVY BENPR BHPHI CCPQU CWDGH DWQXO FYUFA GHDGH GNUQQ HCIFZ K9. LK8 M0S M7P PHGZM PHGZT PIMPY PKEHL PQEST PQGLB PQQKQ PQUKI 7X8 5PM DOA |
DOI | 10.34172/japid.2021.008 |
DatabaseName | CrossRef ProQuest Central (Corporate) Health & Medical Collection ProQuest Central (purchase pre-March 2016) ProQuest SciTech Collection ProQuest Natural Science Collection Hospital Premium Collection Hospital Premium Collection (Alumni Edition) ProQuest Central (Alumni) (purchase pre-March 2016) ProQuest Central (Alumni) ProQuest Central UK/Ireland ProQuest Central Essentials Biological Science Collection ProQuest Central Natural Science Collection ProQuest One Middle East & Africa Database ProQuest Central Korea Proquest Health Research Premium Collection Health Research Premium Collection (Alumni) ProQuest Central Student SciTech Premium Collection ProQuest Health & Medical Complete (Alumni) ProQuest Biological Science Collection ProQuest Health & Medical Collection Biological Science Database ProQuest Central Premium ProQuest One Academic (New) Publicly Available Content Database ProQuest One Academic Middle East (New) ProQuest One Academic Eastern Edition (DO NOT USE) ProQuest One Applied & Life Sciences ProQuest One Academic ProQuest One Academic UKI Edition MEDLINE - Academic PubMed Central (Full Participant titles) DOAJ Directory of Open Access Journals |
DatabaseTitle | CrossRef Publicly Available Content Database ProQuest Central Student ProQuest One Academic Middle East (New) ProQuest Central Essentials ProQuest Health & Medical Complete (Alumni) ProQuest Central (Alumni Edition) SciTech Premium Collection ProQuest One Community College ProQuest Natural Science Collection ProQuest Central ProQuest One Applied & Life Sciences Health Research Premium Collection Middle East & Africa Database Health and Medicine Complete (Alumni Edition) Natural Science Collection ProQuest Central Korea Biological Science Collection ProQuest Central (New) ProQuest Biological Science Collection ProQuest One Academic Eastern Edition ProQuest Hospital Collection Health Research Premium Collection (Alumni) Biological Science Database ProQuest SciTech Collection ProQuest Hospital Collection (Alumni) ProQuest Health & Medical Complete ProQuest One Academic UKI Edition ProQuest One Academic ProQuest One Academic (New) ProQuest Central (Alumni) MEDLINE - Academic |
DatabaseTitleList | CrossRef Publicly Available Content Database MEDLINE - Academic |
Database_xml | – sequence: 1 dbid: DOA name: Directory of Open Access Journals url: https://www.doaj.org/ sourceTypes: Open Website – sequence: 2 dbid: BENPR name: ProQuest Central Database Suite (ProQuest) url: https://www.proquest.com/central sourceTypes: Aggregation Database |
DeliveryMethod | fulltext_linktorsrc |
Discipline | Dentistry |
EISSN | 2645-5390 2008-7756 |
EndPage | 34 |
ExternalDocumentID | oai_doaj_org_article_4b52c56f87b542dc841dcc032ea7294a PMC9327490 10_34172_japid_2021_008 |
GroupedDBID | 34H AAYXX ALMA_UNASSIGNED_HOLDINGS CITATION EOJEC GROUPED_DOAJ M~E OBODZ OK1 PGMZT RPM 3V. 7X7 7XB 8FE 8FH 8FI 8FJ 8FK ABUWG ACPRK ADBBV AFKRA AHMBA ALIPV AZQEC BAWUL BBNVY BENPR BHPHI BPHCQ CCPQU CWDGH DIK DWQXO FYUFA GNUQQ GX1 HCIFZ HMCUK K9. LK8 M7P PHGZM PHGZT PIMPY PKEHL PQEST PQGLB PQQKQ PQUKI PROAC RNS TR2 UKHRP WOW 7X8 5PM |
ID | FETCH-LOGICAL-c3338-1a197ef3f1bc5bd8cffc5e1c6c0a9d462eaa8355146d0645d327f0d422f75f473 |
IEDL.DBID | DOA |
ISSN | 2645-5390 2008-7748 |
IngestDate | Wed Aug 27 00:53:54 EDT 2025 Thu Aug 21 18:22:14 EDT 2025 Thu Jul 10 21:05:13 EDT 2025 Fri Jul 25 12:06:21 EDT 2025 Tue Jul 01 03:02:25 EDT 2025 |
IsDoiOpenAccess | true |
IsOpenAccess | true |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 1 |
Language | English |
License | This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
LinkModel | DirectLink |
MergedId | FETCHMERGED-LOGICAL-c3338-1a197ef3f1bc5bd8cffc5e1c6c0a9d462eaa8355146d0645d327f0d422f75f473 |
Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 |
ORCID | 0000-0002-2136-1572 0000-0002-0343-5013 0000-0003-2932-4909 0000-0003-3197-9066 |
OpenAccessLink | https://doaj.org/article/4b52c56f87b542dc841dcc032ea7294a |
PMID | 35919913 |
PQID | 2553027656 |
PQPubID | 2032002 |
PageCount | 7 |
ParticipantIDs | doaj_primary_oai_doaj_org_article_4b52c56f87b542dc841dcc032ea7294a pubmedcentral_primary_oai_pubmedcentral_nih_gov_9327490 proquest_miscellaneous_2697676382 proquest_journals_2553027656 crossref_primary_10_34172_japid_2021_008 |
ProviderPackageCode | CITATION AAYXX |
PublicationCentury | 2000 |
PublicationDate | 2021-00-00 |
PublicationDateYYYYMMDD | 2021-01-01 |
PublicationDate_xml | – year: 2021 text: 2021-00-00 |
PublicationDecade | 2020 |
PublicationPlace | Tabriz |
PublicationPlace_xml | – name: Tabriz |
PublicationTitle | Journal of advanced periodontology and implant dentistry |
PublicationYear | 2021 |
Publisher | Tabriz University of Medical Sciences |
Publisher_xml | – name: Tabriz University of Medical Sciences |
SSID | ssj0002875505 ssj0000392912 |
Score | 2.138783 |
Snippet | Background. This cross-sectional study investigated the bone mineral density (BMD) in type 2 diabetes mellitus (T2DM) subjects with or without chronic... All the participants were evaluated for blood sugar levels using glycated hemoglobin (HbA1c) and BMD by Hologic dual-energy x-ray absorptiometry (DEXA) scan.... This cross-sectional study investigated the bone mineral density (BMD) in type 2 diabetes mellitus (T2DM) subjects with or without chronic periodontitis... |
SourceID | doaj pubmedcentral proquest crossref |
SourceType | Open Website Open Access Repository Aggregation Database Index Database |
StartPage | 28 |
SubjectTerms | absorptiometry scan Adrenocorticotropic hormone Advanced glycosylation end products Age Alveolar bone Antibiotics Bone density Bone growth Bone healing Bone loss Bone mass Bone mineral density Bone remodeling Bone resorption Bone turnover Cardiovascular system Cross-sectional studies Cushing syndrome Cytokines Cytotoxicity Diabetes dual-energy x-ray Fractures glycated hemoglobin a Gram-negative bacteria Gum disease Hemoglobin Homeostasis Hormone replacement therapy Inflammation Insulin resistance Insulin secretion Interleukin 1 Interleukin 6 Lipids Liver diseases Lytic enzymes Metabolic disorders Metabolism Mineralization Nervous system diseases Osteoblastogenesis Osteoporosis Pregnancy Transcription factors Tumor necrosis factor-TNF Vitamin D |
SummonAdditionalLinks | – databaseName: Health & Medical Collection dbid: 7X7 link: http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwfZ07b9RAEMdXEApoEE9hEtAgUdBYsdf7sGlQCEQRBRWRrrP2CUbEPs53Bd-Cj5yZte-CGxpb8kPe9ezjv7Oj3zD2NmjbaFvLvAm1yIWMMrelM3msvPZWW6JjUrTFV3V5Jb6s5Gp2uI1zWOV-TEwDtR8c-chPecpvo1F-fFj_zilrFO2uzik07rJ7hC6jkC690gcfS0GTf9rwTLv8qHTqie6DQ7fmpz_NuiNYKC8JcrqYmBK_fyE6lyGT_8xBF4_Yw1k8wtlk7cfsTuifsPufKOCHcrY9ZX_Pb2HeYA7QTRgi2KEPcN0lyDR4Clvf_oFfFDI0QtcDuWKBw-SK7RyMO0semhHIUQvDJp2H3RbcRNMFIiTjkjYhWcf3cAapWvmYQruolAlc-4xdXXz-dn6ZzzkXclfhajUvTdnoEKtYWietr12MTobSKVeYxgvFgzEo2lBmKU-oO19xHQsvOI9aRqGr5-yoxwq9YGBNFaITXnE8OuWbRleuxHcr4Y1QZcbe7X94u57QGi0uSZJt2mSblmzTom0y9pEMcniMmNjpwrD53s5drBVWcidVrLWVgntXi9I7V1RYZFxBCJOxk70527mjju1ts8rYm8Nt7GK0b2L6MOzwGYWaDcfhmmdML5rBokDLO333I8G6UR9r0RQv___xY_aA6jr5dk7Y0XazC69Q7Wzt69SkbwA68gOU priority: 102 providerName: ProQuest |
Title | Comparative assessment of bone mineral density levels in type 2 diabetic subjects with or without chronic periodontitis: A cross-sectional study |
URI | https://www.proquest.com/docview/2553027656 https://www.proquest.com/docview/2697676382 https://pubmed.ncbi.nlm.nih.gov/PMC9327490 https://doaj.org/article/4b52c56f87b542dc841dcc032ea7294a |
Volume | 13 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrZ1Lb9QwEMctKAe4IJ4itF0NEgcuUdeOHSe99UnFoUKISnuL_BSpSlI1uwe-RT9yZ5ztsjlx4eJIcSLZnon992T0M2Ofg7a1tpXK61DJXKqocsudyWPhtbfaEh2Tsi0uy4sr-W2hFltHfVFO2IgHHgfuQFolnCpjpa2SwrtKcu_cvBDBoC6USRrhmre1mbpOISNN0ntk-eBErcXBtbltCQ0qOCFNJ8tQovVPJOY0QXJrxTl_xV6upSIcjU18zZ6E7g17fkrpPXRC21t2f_IX3Q1mg9iEPoLtuwC_24SUBk9J6ss_cEMJQgO0HVDgFQSMgdfWwbCyFI8ZgMKy0N-la79aghvZuUA8ZNzAJgDrcAhHkLqVDymRi1qZMLXv2NX52c-Ti3x9wkLuCtyb5tzwWodYRG6dsr5yMToVuCvd3NReljjIBiUaiqrSE9jOF0LHuZdCRK2i1MV7ttNhhz4wsKYI0UlfCixd6etaF47ju4X0RpY8Y18eB7y5HUEaDW5Akm2aZJuGbNOgbTJ2TAbZPEYE7HQD_aJZ-0XzL7_I2N6jOZv1Zzk0Ih2SpFHDZuzTpho_KPpLYrrQr_CZEhUazrqVyJieuMGkQdOarv2V0NyohrWs5x__Rw922QsakTHes8d2lnersI8KaGln7Kle6Bl7dnx2-f3HLLk-ll8X_AHgYQ25 |
linkProvider | Directory of Open Access Journals |
linkToHtml | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwzV3LbtNAFB2VdlE2UF5qoMAggcTGrT2e8dhILEpCSWnpqhXdmXlCeNhVnAiVr2DfX-HjuHfspJgFu0psYil24vH4zJ1zr4_PEPLUSV1InYuocDmPuPAi0olRkU-ttFpqdMdEtcVRNj7hb0_F6Qq5WLwLg7LKRUwMgdrWBmvkOyysbyOBfnQKygN3_h3ys-bl_ghu5jPG9l4fD8dRt4RAZFJIvqJEJYV0PvWJNkLb3HhvhEtMZmJVWJ4xpxRwEGANmUXnNpsy6WPLGfNSeC5T-N9rZA2yCgHDZ234fvRmvCzhxMgtwvPUICIAIpW35kEwM0i281mdTdCLlCXoodqb98LyAD1O21dk_jHF7d0kvxad0ypbvmzPZ3rb_PjLN_I_7b0NcqOj1nS3HQu3yIqrbpP1EcqhcEW7O-Tn8NLqnKqlJSmtPdV15ei3SbDgphZF_bNz-hUFVQ2dVBQL1ZTRtlA9MbSZa6xfNRTL2LSehm09n1HTeg1T9I-GhD8Y1jYv6C4NdyVqgvANWxlsfe-SkyvpkHtktYIL2iRUq9R5w23G4NNktihkahL4bcqt4lkyIM8XeCnPWuOREhK2AK0yQKtEaJUArQF5hXhaHoaO4eGLevqx7AJQybVgRmQ-l1pwZk3OE2tMnEKTIb_iakC2FsgpuzDWlJewGZAny90QgPCpkqpcPYdjMmC0MEvlbEBkD8W9BvX3VJNPwcocsgfJi_j-v0_-mKyPj98dlof7RwcPyHW87rYKtkVWZ9O5ewi8cKYfdeOTkg9XDerfA7p1rw |
linkToPdf | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMw1V3NbtNAEF6VVAIu_CMCBRYJJC5u4vXaayMhVBJCSlHFgYre3P2lKWCHOBEqT8Hz8Cq8DDNrO8UcuPXAxZb8u15_np2Z_fwNIY-tUJlQaRxkNuUBj10cqFDLwEVGGCUUqmMi22I_mR7wN4fx4Qb52f4Lg7TK1iZ6Q21KjTnyAfP1bQS4HwPX0CLejScv5l8DrCCFM61tOY0aInv29BuEb9Xz3TG86yeMTV69H02DpsJAoCOIzYJQhpmwLnKh0rEyqXZOxzbUiR7KzPCEWSnBRQGnIjEo7GYiJtzQcMaciB0XEVz3AtnEqk68RzZHH8avp-sMzxBdDz_d6jkG4GeltbYQDByCDU7kfIZSpSxEidXOsOirB3Rc3i5h848RcHKV_Gr7ria-fNpeLdW2_v6XrOT_2bnXyJXGMac79Zd0nWzY4ga5NEYyFdbDu0l-jM6E0qlcC5rS0lFVFpZ-mXkBb2rwl4DlKf2MdKyKzgqKaW7KaJ3mnmlarRRmvyqKSXBaLvy6XC2prpWKKapPl6b0crfVM7pD_UsLKk-bw1Z6UeBb5OBcOuQ26RXwQHcIVTKyTnOTMFjqxGSZiHQI50bcSJ6EffK0hVM-r2VLcgj3PPJyj7wckZcD8vrkJcJtfRjqjfsN5eJj3pivnKuY6ThxqVAxZ0anPDRaDyNoMkRnXPbJVgusvDGCVX6Gqj55tN4N5gvnpGRhyxUck4A_DGNcyvpEdEDeaVB3TzE79kLoEHsIng3v_vvmD8lFAHP-dnd_7x65jI9dp9C2SG-5WNn74FQu1YPm66Xk6Lwx_RvpPY1_ |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Comparative+assessment+of+bone+mineral+density+levels+in+type+2+diabetic+subjects+with+or+without+chronic+periodontitis%3A+A+cross-sectional+study&rft.jtitle=Journal+of+advanced+periodontology+and+implant+dentistry&rft.au=Ateeq%2C+Hira&rft.au=Zia%2C+Afaf&rft.au=Husain%2C+Qayyum&rft.au=Bey%2C+Afshan&rft.date=2021&rft.issn=2645-5390&rft.eissn=2645-5390&rft.volume=13&rft.issue=1&rft.spage=28&rft.epage=34&rft_id=info:doi/10.34172%2Fjapid.2021.008&rft.externalDBID=n%2Fa&rft.externalDocID=10_34172_japid_2021_008 |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=2645-5390&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=2645-5390&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=2645-5390&client=summon |