Association between periodontal disease and osteoporosis in post-menopausal women: a systematic review and meta-analysis

Qi, J., Chen, J., Pang, Y., Guo, Y., Chen, G., Liu, Y., Wang, J. (2023) ‘Association between periodontal disease and osteoporosis in postmenopausal women: a systematic review and meta-analysis’, Heliyon, 9(11).


Although women represent a significant proportion of the patient population, female representation in the fields of dental and medical research has been consistently lacking, leading to adverse clinical implications and a gender gap in health outcomes. Despite this underrepresentation, sex and gender are important determinants of health, with a key example being the physiological changes that occur in women during specific stages of life, including puberty, pregnancy and menopause. A current area of research is the association between post-menopausal osteoporosis (PMO, disorders in bone metabolism caused by post-menopausal oestrogen decline) and periodontal disease (PD, oral illnesses affecting the supporting structures of the teeth), as recent studies have suggested that PMO is a risk factor for PD. A previous systematic review assessed the relationship between PMO and periodontal attachment loss only, thus this systematic review is the first, comprehensive investigation of the relationship between PMO and PD.


The PICO (population, interventions, comparators and outcomes) framework was used to determine study eligibility criteria. The population consisted of post-menopausal women with osteoporosis, with the comparator being post-menopausal women without osteoporosis and the outcomes being various periodontal clinical measures (Table 1). A systematic search of Medline/PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, CNKI, CBM, VIP and Wanfang databases from inception to 1st July 2023 led to the identification of 28 total studies, including but not limited to controlled trials, case-control studies and retrospective analyses. Data analysis was carried out using the Revman 5.4 program. 

Results and Discussion

The main finding of the data analysis of all studies was that there were significant differences between the means of the PMO and non-osteoporosis groups in all periodontal measures (Table 1), apart from ACH, with the PMO group’s results consistently indicating increased PD severity. Furthermore, the studies were divided into sub-groups according to study methodology and all of the sub-analyses indicated that the PMO groups had a greater proportion of patients with PD than the non-osteoporosis groups, suggesting that PMO increases the likelihood of developing PD.

The high correlation between PMO and PD found in this study is consistent with previous conclusions. The principal molecular link between these two disorders is thought to be pro-inflammatory mediators, including IL-1 and IL-6, that contribute to disease progression by impacting osteoclast activity, and exacerbating the inflammatory response to hasten systemic and periodontal bone resorption. Additionally, the decline in oestrogen production, and subsequent reduction in osteoclast suppression, observed in menopause is considered to be another mechanism.


In conclusion, the findings of this study indicate that the presence of osteoporosis increases both PD susceptibility and severity in post-menopausal women, and that this relationship is likely to be bi-directional. Moreover, the hormonal changes that occur in menopause are a risk factor for both diseases. These conclusions not only consolidate the relationship between oral and systemic health, but they also highlight the importance of representation in clinical research as a means to further understand the impact of health determinants on individuals’ experiences of disease, and ensure optimal health outcomes for all communities.

Research Summary Written By: Shanshan Cao, University of Central Lancashire – BDS2

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