Abstract
BackgroundThe purpose of this study was to investigate the relationship between hormone replacement therapy (HRT) and periodontal disease in postmenopausal women using data from the 4th and 5th Korea National Health and Nutrition Examination Survey (KNHANES).MethodsThe study included data from 5,482 postmenopausal women aged 45–74 years in the 2007–2012 KNHANES. The use of female HRT for at least one month was reclassified as HRT+/HRT-. The Community Periodontal Index of Treatment Needs (CPITN) was used to assess periodontal status. Propensity score matching (PSM) was used to control selection bias, and factors affecting education, family income, and age of menopause were used as covariates in PSM. A chi-square test was used to confirm the bivariate relationship between the variables. Binary logistic regression analysis was used to adjust for confounders (age, education, family income, body mass index, age of menopause, alcohol, smoking, dental clinic visits in the past one year, use of oral care products and frequency of tooth brushing per day).ResultsAfter adjusting for all covariates, HRT was associated with periodontal disease (OR: 0.79; 95% CI: 0.66–0.94). In particular, the relationship between HRT and periodontal disease was more evident in those with menopause under 45 years of age disease (OR: 0.55; 95% CI: 0.35–0.87).ConclusionsThe results of this study supported that it is important that hormone therapy be actively considered in the policy towards postmenopausal women. Especially, health programs such as hormone replacement therapy, non-smoking, and use of oral care products are needed for women who undergo premature menopause.
Highlights
The purpose of this study was to investigate the relationship between hormone replacement therapy (HRT) and periodontal disease in postmenopausal women using data from the 4th and 5th Korea National Health and Nutrition Examination Survey (KNHANES)
Analysis of differences before and after propensity score matching After matching for education level, household income, and age of menopause, based on the analysis of differences before and after PSM of all study populations, prematching differences in covariates according to HRT+/ HRT- are shown on the left side and post-matching differences are shown on the right side
Variables that exhibited differences based on HRT+/− prior to matching – including education level, household income, and age of menopause – no longer showed differences based on HRT+/− after matching, suggesting that PSM has been successfully completed (Table 1)
Summary
The purpose of this study was to investigate the relationship between hormone replacement therapy (HRT) and periodontal disease in postmenopausal women using data from the 4th and 5th Korea National Health and Nutrition Examination Survey (KNHANES). The average menopausal age of women in Korea is 49.7 years. Menopause is a phenomenon that occurs naturally with aging, but postmenopausal women face increased risk of various diseases, including osteoporosis and cardiovascular diseases [5]. Osteoporosis and periodontal diseases are indicative of excessive bone resorption, as both diseases have host-dependent, multifactorial causes and are regulated by local and systemic cytokines, such as IL-1 and 6, and various hormones [7]. Menopause-related hormonal changes are known to affect the oral environment, due to changes in sex hormones, such as estrogen, progesterone, and testosterone, which have an impact on the secretion of proinflammatory cytokines that are involved in bone resorption [9]. Estrogen receptors in the oral mucosa react sensitively to changes in hormone levels, which leads to increased inflammation in the periodontal tissues [10]
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