The pattern of alveolar crest height change in healthy postmenopausal women after 3 years of hormone/estrogen replacement therapy.

BACKGROUND: The loss of ovarian function at menopause is associated with loss of postcranial and oral bone. Hormone/estrogen replacement therapy (HRT/ERT) has a positive effect on both postcranial and oral bone. The objective of the study was to determine if the positive effect of HRT/ERT on alveolar crest height (ACH) is generalized or site specific. METHODS: The sample consisted of 49 women who completed a 3-year, HRT/ERT prospective study. Cemento-enamel junction distances (ACH) were measured on digitized images of bitewing radiographs. Lumbar spine and proximal femur bone mineral densities (BMDs) were determined with dual-energy x-ray absorptiometric scans. Measurements were made at baseline and at the end of year 3. For the 3-year study period, mean change in ACH was determined for each patient. In addition, the sites with the greatest, second and third greatest ACH changes were determined for each patient. Correlations between changes in ACH (as determined by the various methods) and postcranial BMD were determined. RESULTS: Mean ACH changes had an average correlation (r) of -0.24 with femoral and lumbar spine BMDs. Although the largest site-specific change in ACH resulted in a mean correlation of -0.21, the correlations for the second and third largest changes in ACH dropped to -0.15 and -0.12. Overall, the correlations for site-specific changes were substantively smaller than those for generalized change. CONCLUSIONS: The data of this study indicate that ACH change attributable to HRT/ERT is generalized rather than site specific. Studies of the effect of HRT/ERT on ACH should employ multiple measurements to minimize measurement errors associated with site-specific measurements.

Alveolar and postcranial bone density in postmenopausal women receiving hormone/estrogen replacement therapy: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: We conducted a 3-year, double-blind, randomized, placebo-controlled study to determine whether the positive effects of hormone/estrogen replacement therapy (H/ERT) on postcranial bone density are accompanied by similar positive effects on oral bone mass. METHODS: A total of 135 postmenopausal women (aged 41-70 years) with no evidence of moderate or severe periodontal disease were randomized to receive daily oral conjugated estrogen (Premarin; 0.625 mg) alone or in combination with medroxyprogesterone acetate (Prempro; 0.625 and 2.5 mg, respectively) or placebo. All subjects received calcium carbonate (1000 mg/d) and cholecalciferol (400 [corrected] IU/d) supplements. The primary efficacy end points were the changes in alveolar crest height and alveolar bone density. Alveolar crest height was measured on bite-wing radiographs, and changes in alveolar bone mass were assessed by means of digital-subtraction radiography. Postcranial bone density was measured in the lumbar spine and left proximal femur by means of dual-energy x-ray absorptiometry. RESULTS: Hormone/estrogen replacement therapy significantly increased alveolar bone mass compared with placebo (+1.84% vs +0.95% [P =.04]), and tended to improve alveolar crest height (+4.83% vs +3.46% [P =.34]). Bone mineral density of the proximal femur significantly increased in the H/ERT compared with the placebo group (total proximal femur, +3.59% vs +0.22% [P =.001]; neck, +2.05% vs -0.34% [P =.02]; trochanter, +3.49% vs +0.08% [P<.001]), but not the lumbar spine (+1.01% vs +0.17% [P =.39]). Changes in alveolar bone mass correlated with bone density changes in the total femur (r = 0.28 [P =.02]) and femoral trochanter (r = 0.25 [P =.04]) in the H/ERT but not in the placebo group. CONCLUSIONS: Postcranial and oral bone mass were increased in postmenopausal women receiving H/ERT. Improvement in oral bone health constitutes an additional benefit of H/ERT.

Relationships between radiographic alveolar bone height and probing attachment level: data from healthy post-menopausal women.

OBJECTIVE: To determine the cross-sectional and longitudinal relationships between radiographic alveolar bone height and probing attachment level in a population of healthy postmenopausal women. MATERIALS AND METHODS: The 81 patients in this report were part of a prospective estrogen replacement interventional study. All patients were in good oral health at entry and received annual oral prophylaxis as part of the study. Standard probing measurements were made with a pressure sensitive probe at 6 sites on each tooth. Vertical bitewing radiographs were digitized, and 6 linear measurements corresponding to probing-site measurements were made from the cementoenamel junction to the alveolar crest. These procedures were performed at baseline and at annual intervals for three years. Data were analyzed both by site and by patient. RESULTS: Moderately strong correlations were found between cross-sectional measurements of probing attachment height and radiographic bone height. Correlations were stronger for patient data (r=0.44-0.61) than for site data (r=0.19-0.36). No relationships were found between longitudinal changes in alveolar bone height and attachment level in either the site data (r=-0.10-0.04). or the patient data (r=-0.005-0.10). CONCLUSION: Healthy patients may experience sporadic, temporary changes in attachment level or alveolar bone height which are resolved without one affecting the other.

Alveolar bone height and postcranial bone mineral density: negative effects of cigarette smoking and parity.

BACKGROUND: Our objective was to test the association between cemento-enamel junction, alveolar-crest distance (CEJ-AC, as measured on digitized vertical bite-wing radiographs) and postcranial bone mineral density (BMD) relative to clinical, dietary, and demographic variables. METHODS: Data were collected in a cross-sectional study of 134 postmenopausal women. CEJ-AC distances were determined from digitized vertical bite-wing radiographs. Lumbar spine and proximal femur BMDs were determined from dual-energy x-ray absorptiometric scans. Correlation analysis and Student t tests were used to identify those variables most associated with CEJ-AC distance. The selected variables were modeled with a backward stepwise regression analysis, with CEJ-AC distance as the dependent variable. RESULTS: Parity (number of pregnancies to term), cigarette smoking, and the interaction of lateral spine BMD with cigarette smoking were independent predictors of CEJ-AC distance (P < or =0.05). Statistical models containing these variables accounted for 19% of the variation in CEJ-AC distances. CONCLUSIONS: CEJ-AC distance in postmenopausal women is the result of a complicated interaction of many effects, including but not limited to, parity, cigarette smoking, and skeletal BMD.

Comparison of morphological measurements extracted from digitized dental radiographs with lumbar and femoral bone mineral density measurements in postmenopausal women.

BACKGROUND: We set out to determine whether morphologic measurements extracted from digitized images of bite-wing radiographs correlated with lumbar and femoral bone mineral density (BMD) measurements in 45 postmenopausal women who had no or only mild periodontal disease (no probing depths >5 mm). METHODS: Lumbar spine and femoral BMDs were determined by dual-energy x-ray absorptiometry. Vertical bite-wing radiographs were taken and digitized. Crestal and apical regions of interest (ROIs) were drawn on the digital images of the maxillary and mandibular alveolar bone on the patient's right and left sides. For each patient, a single morphologic measurement was made for each of 8 ROIs. Correlation analysis was performed to determine the strengths of the relationships between the morphologic measurements made at the 8 locations and between these morphologic measurements and BMD measurements. RESULTS: The correlations (r) between the morphologic operator (MO) measurements and lumbar spine and femoral BMDs were weak (mean r = 0.02, range = 0.32 to -0.26) and not statistically significant, with no clear trends discernible. Correlations between MO measurements made at the 8 alveolar sites were also weak (mean r = 0.05, range = 0.35 to -0.38) and not statistically significant. CONCLUSIONS: The MO measurements used in this study were weakly correlated with lumbar spine and femoral BMDs, with no clear trends discernible in this population of postmenopausal women with no or mild periodontal disease.

The effect of region of interest variations on morphologic operations data and gray-level values extracted from digitized dental radiographs.

OBJECTIVE: To determine the correlations among morphologic operations (MO) values and the correlations among gray-level values for regions of interest (ROIs) placed at various locations on digital images of alveolar bone for 45 patients. STUDY DESIGN: As part of a larger study, up to 7 vertical bite-wing radiographs were taken and digitized for each of 45 patients. Sets of 2 rectangular ROIs were placed on the digitized images of interdental alveolar bone at 4 locations for each patient. The ROIs (1 crestal and 1 apical) were placed between second premolars and first molars in all 4 dental quadrants. Gray-level values were measured, and MO analysis was performed on each ROI. Descriptive statistics were calculated and correlations determined. RESULTS: Paired correlations (such as apical vs crestal, left vs right, maxillary apical vs mandibular apical) of MO values were weak (r = 0.01-0.21), but corresponding correlations for gray-level values were relatively strong (r = 0. 60-0.92). CONCLUSION: MO values varied with ROI location considerably more than did gray-level values. Additionally, ROI size and shape apparently affected MO data. Accurate placement and documentation of ROIs appear to be critical considerations in analyses that use MOs.

Relationships between longitudinal changes in radiographic alveolar bone height and probing depth measurements: data from postmenopausal women.

BACKGROUND: The relationship between loss of radiographic alveolar bone height and probing attachment loss has been studied by a number of investigators, with mixed results. Recent studies have found weak correlations and have suggested that the relationship between bone loss and attachment loss is complex, perhaps because changes in bone height and attachment level are separated in time. METHODS: The 85 patients in this report were part of a prospective estrogen replacement interventional study. All patients were in good oral health at entry and received annual oral prophylaxis as part of the study. Standard probing measurements were made with a pressure-sensitive probe at 6 sites on each tooth. Vertical bite-wing radiographs were taken of each patient, radiographs were digitized, and 6 linear measurements (corresponding to probing site measurements) were made from the cemento-enamel junction to the alveolar crest. These procedures were performed at baseline and at annual intervals; this study reports results after 2 years. Data were analyzed both by individual site and by averaging identical sites from all measured teeth for each patient. RESULTS: Very weak direct relationships between change in alveolar bone height and change in attachment level were found in both the site data (r2=0.0022; P = 0.189) and the patient average data (r2=0.031; P= 0.104). CONCLUSIONS: The changes in these patients were probably due to systemic changes in bone health rather than to periodontal disease. However, the weak correlations between changes in attachment level and bone height are similar to recent studies of periodontal disease. Our results support suggestions in the literature that the link between changes in attachment and alveolar bone height is complex, perhaps because changes in the 2 tissue types are separated by a considerable time delay.

Attachment loss with postmenopausal age and smoking.

To determine whether postmenopausal bone loss and factors associated with osteoporosis affect tooth retention, we examined vertebral and proximal femoral (postcranial) bone mineral density in relation to tooth loss and attachment loss in a cross-sectional study of 135 postmenopausal women (age range 41-70 yr). Women had at least 10 teeth and no evidence of moderate or severe periodontal disease. Full-mouth attachment loss measurements were made using a pressure-sensitive probe, and bone density was determined by dual-energy X-ray absorptiometry. Attachment loss was correlated with tooth loss (number of remaining teeth, radiologically determined), but not with vertebral or proximal femur bone density. Multivariate analysis showed current smoking (p = 0.01), years since menopause (p = 0.02) and the interaction of age and current smoking (p < 0.01), to be statistically significant predictors of attachment loss in our study population.