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...

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Published inJournal of advanced periodontology and implant dentistry Vol. 13; no. 1; pp. 28 - 34
Main Authors Ateeq, Hira, Zia, Afaf, Husain, Qayyum, Bey, Afshan
Format Journal Article
LanguageEnglish
Published Tabriz Tabriz University of Medical Sciences 2021
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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
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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...
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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
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Title Comparative assessment of bone mineral density levels in type 2 diabetic subjects with or without chronic periodontitis: A cross-sectional study
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