Clinical and radiological improvement of periodontal disease in patients with type 2 diabetes mellitus treated with alendronate: a randomized, placebo-controlled trial.

BACKGROUND: Alendronate (ALN) is an aminobisphosphonate commonly used for osteoporosis in postmenopausal women. We studied the effect of ALN on bone loss prevention in type 2 diabetes mellitus patients with periodontal disease. METHODS: In a controlled double-blind, randomized study we evaluated prospectively diabetic patients paired by gender and years since diagnosis for 6 months. The study included 40 patients (20 men and 20 women), 50 to 60 years old, with more than 5 years since diagnosis of diabetes and established periodontitis. They were randomly allocated to alendronate (10 mg/daily) or placebo treatment for 6 months. The endpoints of treatment were: the distance between the alveolar bone border and the cemento-enamel-junction (CEJ) evaluated by means of digital radiographic imaging, a biochemical marker of bone resorption (urine N-telopeptide) (Ntx), and periodontal parameters. Metabolic control was assessed at baseline and after 6 months. RESULTS: Baseline and 6-month glycated hemoglobin levels were similar in both groups. Alendronate induced a significant decrease in NTx at 6 months (P = 0.006). Periodontal parameters improved in both groups. However, they were significantly better for the ALN treated group. Alveolar bone border-CEJ distance increased in the placebo, but decreased in the ALN group (P = 0.0003). CONCLUSIONS: In type-2 diabetic patients, alendronate induced more improvement in alveolar bone crest height than control therapy. No differences in urinary N-telopeptide or glycated hemoglobin were observed in this short-term randomized controlled pilot trial.

Periodontal disease in non-insulin dependent diabetes mellitus (NIDDM). The effect of age and time since diagnosis.

The association of periodontal disease with diabetes was studied in non-insulin dependent diabetes mellitus (NIDDM) patients. In a cross-sectional design, 100 patients (46 males and 54 females) were selected in 4 groups according to age and years since diagnosis of diabetes. The groups were: group 1, > 55 years old, diabetes diagnosed > or = 5 years; group 2, < or = 55 years old, diabetes diagnosed > or = 5 years; group 3, > 55 years, diabetes diagnosed < 5 years; and group 4, < or = 55 years, diabetes diagnosed < 5 years. Buccal and lingual pockets were deeper and lingual and buccal recessions greater for groups diagnosed 5 or more years ago, (P < 0.0001). In groups diagnosed less than 5 years, higher recession indices were found for patients older than 55. The loss of buccal insertion was also greater for groups diagnosed 5 or more years ago (P < 0.0001). For groups diagnosed less than 5 years ago, the loss was greater in the group older than 55 (P = 0.01). There was a marginal difference in gingival bleeding among the 4 groups (P = 0.047). Post-hoc analysis showed differences between the 2 groups who had been diagnosed less than 5 years, with lower indices for patients < or = 55. All groups were statistically different regarding bone loss (P < 0.0001), with higher indices for the groups with older age, and for groups with 5 or more years since diagnosis. There was no difference in dental mobility among the 4 groups (P = 0.0981). It was concluded that years since diagnosis of diabetes is more significant than age for severity of periodontal disease in NIDDM.