Personalized approach to diagnosing periodontitis in patients with reduced bone mineral density during menopause

Aim of study.
The study was carried to develop a personalized approach to diagnosing periodontitis in menopausal patients.
Material and methods. The study involved 140 female patients with moderate to severe chronic generalized periodontitis (CGP) aged 55–65 years. The patients were divided into the following groups: Group I – 60 patients diagnosed with generalized osteoporosis; Group II – 40 patients with osteopenia; Group III – 40 subjects with normal bone mineral density. The comparison group included 30 patients of reproductive age with moderate to severe CGP bearing no signs of reduced bone mineral density. The control group were 20 females of reproductive age with practically healthy periodontium. The patients underwent a standard examination of the periodontal complex, and had their oral fluid assessed to detect the content of biomarkers reflecting bone metabolism (P-CrossLaps, osteocalcin). The mediators of the APUD system (serotonin, VEGF, CD35) were studied in the marginal gingival mucosa by immunohistochemistry.
Results. Patients with periodontitis on the background of osteoporosis were characterized by increased concentration of CrossLaps and decreased content of osteocalcin in oral fluid, which changed accordingly to the severity of periodontitis. The T-score BMD index in the L1–L4 region correlated with the levels of bone remodeling markers. The expression area of serotonin-positive gingival epithelial cells increased proportionally to the severity of perio- dontitis, regardless of any osteopenic syndrome present or normal skeletal BMD. The expression of VEGF (vascular endothelial growth factor) and CD35 (dendritic cells) in patients with concomitant osteopenia and osteoporosis was significantly lower than in postmenopausal women with normal BMD. Conclusion. The studied oral fluid biomarkers (P-CrossLaps, osteocalcin), as well as the morphometric expression analysis of the gingival cells that are immunopositive to CD35, VEGF can be effectively used in the diagnosis and assessment of treatment efficacy in patients of this category.
Key words: periodontitis, osteoporosis, osteopenia, menopause, biomarkers, bone mineral density, oral fluid, serotonin, dendritic cells, VEGF
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study.