Lower Bone Loss Research Articles

Radiological Evaluation of Marginal Bone Loss around Dental Implants with Two Different Collar Designs

Objective: To compare mean peri-implant Marginal Bone Loss in patients receiving dental implants with micro-threaded collars with those receiving dental implants with machined collars. Study Design: Quasi-experimental study. Place and Duration of Study: Prosthodontics Department, Armed Forces Institute of Dentistry, Rawalpindi Pakistan, from Feb to Aug 2022. Methodology: Marginal bone loss surrounding dental implants was evaluated by measuring peri-implant bone levels at the time of placement (T0), and at 3 months (T1) and 6 months (T2) after placement. Bone level around implant was measured from the top of dental implant to the first point of contact between the marginal bone and implant body with the help of digital peri apical radiograph (Care stream RVG 6500) with built in software measuring tool (Dental Imaging Software 6.14.0). Results: A total of 80 implants were placed in which 40 were with rough micro-threaded collar (Group-A) and 40 were with smooth machined collar (Group-B). Out of 80 patients, 51(63.75%) were males and 29(36.25%) were females. Mean and SD of age in years was 40.52±11.75 years. Highest bone loss was at T2 in machined collar implant i.e. 0.72±0.04 mm, and lowest bone loss at T2 in micro-threaded collar implant i.e. 0.54±0.04 mm. A statistically significant difference was found between MBL in machined and micro-threaded implants at T2 (p-0.001). Conclusion: Marginal bone loss around rough-surfaced micro-threaded collar implants was significantly lower than machined collar implants.

A Study of 42 Partially Edentulous Patients with Single-Crown Restorations and Implants to Compare Bone Loss Between Crestal and Subcrestal Endosseous Implant Placement.

BACKGROUND The purpose of the study was to evaluate the influence of dental implant placement at different bone levels upon the resultant postoperative peri-implant bone loss. MATERIAL AND METHODS Forty-two partially edentulous patients seeking implant-supported single-crown restorations were screened followed by segregation into 2 groups (GP), GP E (equicrestal) and GP S (subcrestal) (n=21 each). Sixty endosseous implants (30 each) (Adin Tourage-S, Israel), size 3.5/8 and 4/10 mm for mandibles, were placed using a 2-stage surgical procedure. At 4 to 6 months, straight abutments were attached followed by restoration (Vita Zahnfabrik, Germany). Crestal bone levels (mesial/distal) of implant fixtures were assessed at 5 time intervals (after surgery, and at 3, 6, 9, and 12 months) using digital radiography. Means and standard deviations were calculated, following which the differences were statistically analyzed using ANOVA at P value of <0.05. RESULTS The mean annual bone loss for GP S (1.96 mm) was higher than GP E (1.10 mm). At all studied time intervals, the bone loss for implants in GP S was higher than in GP E (P<0.05). Between time intervals, lowest bone loss was observed on the distal side in GP E (0.11 mm/6-9 month) and the highest bone loss was observed on the distal side of GP S (0.6 mm/9-12 month). Differences in the means between the 2 groups on mesial and distal sides were statistically significant at all time intervals (P<0.05). CONCLUSIONS Subcrestal implant placement was associated with more bone loss than when implants are placed at the crestal level.

The effects of Lactobacillus reuteri on the inflammation and periodontal tissue repair in rats: A pilot study

ObjectiveThe aim of this study was to evaluate the effects of probiotic (PRO) Lactobacillus reuteri (DSM17938) as an adjuvant to the treatment of experimental periodontitis (EP). Material and methodsFifty-four male adult Wistar rats were included. EP was induced and maintained for 7 days. Subsequently, the ligature was removed and the animals were allocated into three different experimental groups (n = 18/group): EP – no local treatment, the animals received four systemic saline solution (SS) administrations; SRP+SS, the animals underwent SRP treatment, followed by SS administration; and SRP+PRO, the animals received SRP treatment, followed by the systemic administration of PROs (Lactobacillus reuteri ; 0.16 ml/day). Six animals from each group were euthanised at 7, 15 and 30 days. Histological and histometric analyses of alveolar bone loss (BL) and immunohistochemical analyses for TRAP, RANKL, OPG, OCN, and PCNA were performed. Shapiro–Wilk, ANOVA, post-hoc Tukey, Kruskal–Wallis, Student–Newman Keuls were performed. ResultsThe SRP+PRO group presented a reduction in inflammation. At 15 days, a lower BL was observed in the SRP+SS and SRP+PRO groups. Greater immunolabeling was noticed for PCNA at 15 days in the SRP+PRO group than in the SRP+SS group. The SRP+PRO group demonstrated a higher OCN immunolabeling pattern than the EP group at 15 and 30 days. ConclusionThe use of Lactobacillus reuteri as an adjuvant to SRP for the treatment of EP showed promising results in the control of local inflammatory responses, and enhanced the periodontal tissue repair process according to the employed concentration.

Peri-Implant Tissue Behaviour Next to Different Titanium Surfaces: 16-Year Post-Trial Follow-Up

The present post-trial follow-up investigated the influence of titanium implants with different surface treatments on clinical behavior of soft and hard peri-implant tissues. Each of the 18 included patients received at least two adjacent implants: one control implant with a dual acid-etched (DAE) surface in their apical portion and a machined coronal part, and one test implant with a DAE surface up to its coronal portion. Peri-implant bone level change (BLC), probing depth (PD), bleeding on probing (BOP) and plaque index (PI) were recorded. A total of 42 implants was inserted. The mean follow-up period was 9.3 years (range: 5–16 years) and there were six dropouts. No implant failed. Moderate crestal bone remodeling occurred during the first year after implant insertion, with lower bone loss next to test implants compared to control ones (0.80 vs. 1.39 mm; p = 0.002). This difference was also detected at the 5- (p = 0.011), 6- (p = 0.008) and 7-year follow-up appointment (p = 0.027). No statistically significant differences were found in bone resorption between implants rehabilitated with ceramic vs. composite resin veneering material. No statistically significant differences were detected between test and control implants for BOP, PI, and PD at any time point. The results of the present study suggest that DAE surfaces reduce peri-implant bone loss in the initial phase of healing compared to machined surfaces, while they do not significantly affect soft peri-implant tissue and bone maintenance in the long-term. In conclusion, the minimally rough surfaces favour peri-implant bone maintenance and their effect is greater in the first year post implant insertion.

Personalized and Defect-Specific Antibiotic-Laden Scaffolds for Periodontal Infection Ablation.

Periodontitis compromises the integrity and function of tooth-supporting structures. Although therapeutic approaches have been offered, predictable regeneration of periodontal tissues remains intangible, particularly in anatomically complex defects. In this work, personalized and defect-specific antibiotic-laden polymeric scaffolds containing metronidazole (MET), tetracycline (TCH), or their combination (MET/TCH) were created via electrospinning. An initial screening of the synthesized fibers comprising chemo-morphological analyses, cytocompatibility assessment, and antimicrobial validation against periodontopathogens was accomplished to determine the cell-friendly and anti-infective nature of the scaffolds. According to the cytocompatibility and antimicrobial data, the 1:3 MET/TCH formulation was used to obtain three-dimensional defect-specific scaffolds to treat periodontally compromised three-wall osseous defects in rats. Inflammatory cell response and new bone formation were assessed by histology. Micro-computerized tomography was performed to assess bone loss in the furcation area at 2 and 6 weeks post implantation. Chemo-morphological and cell compatibility analyses confirmed the synthesis of cytocompatible antibiotic-laden fibers with antimicrobial action. Importantly, the 1:3 MET/TCH defect-specific scaffolds led to increased new bone formation, lower bone loss, and reduced inflammatory response when compared to antibiotic-free scaffolds. Altogether, our results suggest that the fabrication of defect-specific antibiotic-laden scaffolds holds great potential toward the development of personalized (i.e., patient-specific medication) scaffolds to ablate infection while affording regenerative properties.

Influence of Doxycycline and InGaAlP Diode Laser at 660 nm Wavelength in the Treatment of Periodontitis Induced in Rats: In Vivo Study.

This study evaluated the influence of Doxycycline (DOX) and Low-Intensity Laser (LIL) (InGaAlP diode laser) as scaling and root planing (SRP) adjuvants in the treatment of periodontitis induced in rats. The rats received periodontal disease induction, and after 7days, the ligature was removed, and the animals were divided into groups/treatments: NT-receive no treatment; SRP-submitted only to SRP; DOX-submitted to SRP and DOX irrigation; LIL-submitted to SRP and LIL irradiation; and DOX+LIL-submitted to SRP treatments, DOX irrigation and LIL irradiation. The animals were sacrificed at 7, 15 and 30days, and then, the analyses were performed. A lower concentration of Alpha-glycoprotein acid and Complement 3 was observed in the DOX+LIL group compared to all the other groups in all the periods, and for Complement 4 at 15 and 30days (P<0.01). A lower bone loss (BL) was observed in the DOX+LIL group compared to all the other groups in all the periods (P<0.01). It can be concluded that LIL was effective in the reduction of proteins, and its association with DOX was effective in the reduction of proteins and BL, in the treatment of periodontal induction in rats.

DIAGNOSIS AND TREATMENT DROG INDUCED GINGIVAL HYPERPLASIA

Gingival hyperplasia is an increase in the number of cells and represents exuberant response of the gingival tissue against local and systemic conditions. Some drugs produce changes in oral tissues. Of calcium channel blockers, nifedipine produce gingival enlargement more often. The objective of this study was to report the case of male patient, 57 years old, who attended the dental clinic Unipê complaining of gingival bleeding and no history of diagnosis after visiting a dentist in other institutions. The patient reported having had chronic kidney disease, hypertension, while making use of drugs: furosemide®, ranitina ®, cyclosporine® and captopril®. On examination, there was an increase of the gingival tissue of uneven surface with lobulations involving the middle third of the lower incisors, tooth mobility and bone loss. Once the diagnosis of gingival hyperplasia drug should clarify the patient and the etiology of the disease and treatment options, such as gingiva plasty, warning of the imminent possibility of relapse. As well as guide the patient to seek medical advice for conducting review of medications. It is relevant to the recognition of a systemic change places, and seek through an interview and performed and directed, to observe the cause-effect relationship.

Comparison of cylindrical and tapered stem designs for femoral revision hip arthroplasty

BackgroundBoth cylindrical and tapered stems are commonly used in revision total hip arthroplasty. However, whether the geometry of prosthesis stem has an effect on patient prognosis is unclear. We assume that the tapered stem results in better clinical outcome than the cylindrical stem.MethodsA multicenter review of 120 femoral revisions with Paprosky I, II, and III defects using cobalt chrome cylindrical stem (54 hips) or titanium tapered stem (66 hips) was performed with an average follow-up of 6 years. Demographic data were comparable between groups.ResultsNo significant group differences were found in surgery time, bleeding volume, postoperative Harris Hip Score, level of overall satisfaction, and 8-year cumulative survival. However, intraoperative fractures occurred significantly less in the tapered group (4.5%) than in the cylindrical group (14.8%), and stem subsidence was significantly less in the tapered group (2.17 mm) than in the cylindrical group (4.17 mm). A higher ratio of bone repair and lower bone loss were observed in the tapered group compared with the cylindrical group. The postoperative thigh pain rate was higher in the cylindrical group (12.9%) than in the tapered group (4.5%).ConclusionBoth cylindrical stem and tapered stem can achieve satisfactory mid-term clinical results in revision total hip arthroplasty. The tapered stem has better bone restoration of proximal femur, lower incidence of intraoperative fractures, and lower postoperative thigh pain rate compared with the cylindrical stem.

Cinnamic acid decreases periodontal inflammation and alveolar bone loss in experimental periodontitis.

Periodontitis is the chronic destructive disease of the periodontium, which causes severe inflammation in the tissues. Cinnamic acid as an unsaturated carboxylic acid might prevent inflammation and periodontal destruction. The present study aimed to evaluate the effects of cinnamic acid in two different forms as free cinnamic acid and cinnamic acid liposome on experimental periodontitis in Wistar rats. Thirty-two female rats were used in the present study. Four main groups were created as follows: C: control group; P: periodontitis group; C-P: free cinnamic acid-administered periodontitis group; and CL-P: cinnamic acid liposome applied group. Periodontitis was induced via ligating 4-0 silk sutures around lower first molar teeth on both right and left mandibles. The study duration was 30days, and the ligatures were removed from half of the rats in the periodontitis-induced groups. The other half carried the ligatures throughout 30days, and all rats were euthanized at 30th day. Mandibles were removed and evaluated via stereomicroscope and underwent histological procedures. Inflammatory cell counts, osteoblast, and osteoclast cell counts were determined in hematoxylin-eosin-stained slides, and peroxisome proliferator-activated receptor (PPAR)-γ, cyclooxygenase (COX)-2, receptor activator of nuclear factor κ-B (RANKL), and osteoprotegerin (OPG) expressions were evaluated by immunohistochemistry. Control group had the lowest bone loss, and periodontitis group which kept ligatures had the highest bone loss compared to the other groups. Ligature removal provided significant improvement in bone measurements. Cinnamic acid groups also showed lower bone loss compared to the periodontitis group. The inflammatory cell and osteoclast counts were also higher in the periodontitis group, and both applications of cinnamic acid decreased these values. Osteoblast cells were the lowest in the periodontitis group, and cinnamic acid increased these counts. PPAR-γ and COX-2 levels were higher in the periodontitis group, and cinnamic acid decreased these levels but not to a significant level except for the cinnamic acid liposome ligature removal group, which had significantly lower values in the PPAR-γ and COX-2. OPG levels were lower in the periodontitis group compared to the other groups. Cinnamic acid significantly decreased RANKL and increased OPG levels. Periodontitis caused increased inflammation and bone destruction accompanied by increased PPAR-γ, COX-2, and RANKL levels and osteoclast counts. Cinnamic acid decreased osteoclast counts and inflammation and increased osteoblast counts and OPG expression in the present animal model of periodontitis.

HIV Drug Therapy in the Americas 16-18 April 2015, Mexico City, Mexico.

HIV Drug Therapy in the Americas 16-18 April 2015, Mexico City, Mexico.

Association between fat mass, lean mass, and bone loss: the Dubbo osteoporosis epidemiology study

Lower body fat mass is a risk factor for bone loss at lumbar spine in postmenopausal women, but not in men. Body lean mass and fat mass were not associated with femoral neck bone loss in either gender. Bone density and body mass are closely associated. Whole body lean mass (LM) and fat mass (FM) together account for approximately 95 % of body mass. Bone loss is associated with loss of body mass but which of the components of body mass (FM or LM) is related to bone loss is not well understood. Therefore, in this study, we sought to assess whether baseline FM or LM has predictive value for future relative rate of bone mineral density (BMD) changes (%/year). The present population-based cohort study was part of the ongoing Dubbo Osteoporosis Epidemiology Study (DOES). BMD, FM, and LM were measured with dual energy X-ray absorptiometry (GE-LUNAR Corp, Madison, WI). BMD measurements were taken in approximately every 2 years between 2000 and 2010. We only included the participants with at least two BMD measurements at the femoral neck and lumbar spine. In total, 717 individuals (204 men and 513 women) aged 50 years or older were studied. Rate of bone loss at femoral neck and lumbar spine was faster in women than in men (all P < 0.01). In bivariable regression analysis, each 5 kg greater FM in women was associated with 0.4 %/year (P = 0.003) lower bone loss at lumbar spine. This magnitude of association remained virtually unchanged after adjusting for LM and/or other covariates (P = 0.03). After adjusting for covariates, variation of FM accounted for ∼1.5 % total variation in lumbar spine bone loss. However, there was no significant association between FM and change in femoral neck BMD in either men or women. Lower FM was an independent but modest risk factor for greater bone loss at the lumbar spine in women but not in men. If further studies confirm our findings, FM can help predict lumbar spine bone loss in women.

Evidence-based support for S1 transpedicular screw entry point modification

BackgroundIn the literature, ‘below and lateral to the superior S1 facet’ is defined as the basic technique for screw introduction. Until a recently published modification, no analysis for alternative starting point has been proposed nor evaluated, although some surgeons claim to use some modifications. In this study, we analyse the data from anatomical and radiological studies for optimal starting point in transpedicular S1 screw placement.MethodsA Medline search for key word combination: sacrum, anatomy, pedicle, screws and bone density resulted in 26 publications relevant to the topic. After a review of literature, two articles were chosen, as those including the appropriate set of data. The data retrieved from the articles is used for the analysis. The spatial relation of S1 facet, pedicles and vertebral body with cortical thickness and bone density in normal, osteopenic and osteoporotic sacrum is analysed.ResultsPresented data advocates for more medial placement of the screws due to higher bone density and lower bone loss in osteoporosis. Medial shift of the starting point does not increase the risk of spinal canal perforation. Osteoarthritic changes within the facet can augment the posterior supporting point for screw. The facet angular orientation is similar to convergent screw trajectory.ConclusionsModified technique for S1 screw placement takes advantage of latest anatomical and clinical data. In our opinion, technique modification improves the reproducibility and may increase stability and the screws within the posterior cortex of the S1 vertebra. Further biomechanical and clinical study should be performed to prove its superiority to classical technique.

Circulating Periostin Is Elevated In Patients With Hemoglobinopathies and Correlates With Bone Mineral Density In Double Heterozygous Sickle-Cell/Beta-Thalassemia Patients; A Novel Marker Of Bone Strength?

Periostin is a matricellular protein, which seems to play an important role as an anabolic factor in bone tissue development and repair. By binding to cell surface receptors, it can modulate cell adhesion, proliferation, and differentiation, as well as cell-matrix interaction. Periostin is involved in collagen folding, a process which is crucial for matrix assembly and, therefore, for bone strength. However, its exact function on bone biology has not been fully clarified. Patients with hemoglobinopathies develop frequently bone loss, leading to osteopenia or osteoporosis. Several factors are implicated in the pathogenesis of bone destruction in these disorders. Our group has recently shown that activin-A is another factor which contributes to low bone mineral density (BMD) in thalassemia major (TM). Intriguingly, current studies have reported that periostin expression is up-regulated by several members of the TGF-β superfamily, including activin-A. Therefore, the aim of this study was to evaluate circulating periostin levels in a large number of patients with hemoglobinopathies and explore possible correlations with clinical and laboratory data, including BMD and circulating activin-A levels.We studied prospectively 162 patients with hemoglobinopathies: 47 patients had beta-thalassemia major (TM), 30 beta-thalassemia intermedia (TI), 75 double heterozygous sickle-cell/beta-thalassemia (HbS/beta-thal) and 10 had homozygous sickle cell disease (SCD). Circulating periostin was measured in the serum of the patients using an enzyme immunoassay (USCN Life Science Inc, Wuhan, Hubei, China), which has an intra-assay CV<10% and an inter-assay CV<12%. Circulating activin-A was measured using also an enzyme immunoassay (R&D Systems, Minneapolis, MN, USA). BMD of the lumbar spine (L1-L4), femoral neck (FN) and distal radius (R) was measured by dual energy X-ray absorptiometry (DXA) in all patients, at the time of blood sampling, using the Norland XR-26 Mark II densitometer (Norland Scientific Instruments, Fort Atkinson, WI, USA). The in vitro precision by repeated daily phantom measurements was 0.7 %, while the in vivo precision was 1.4 %, established in the laboratory used, by double measurements at weekly intervals. The above molecules were also measured in the serum of 17, age- and gender-matched, healthy individuals who served as controls.Patients with TM (mean±SD: 3227±1148 ng/ml), TI (2907±1255 ng/ml), HbS/beta-thal (3173±1244 ng/ml) and SCD (4300±1411 ng/ml) had elevated circulating periostin compared to controls (597±177 ng/ml, p<0.001 for all comparisons). Furthermore, SCD patients had higher periostin levels compared to patients with TI (p=0.005), HbS/beta-thal (p=0.026) and TM (p=0.029). In all patients, circulating periostin correlated weakly with activin-A (r=0.161, p=0.04), while in patients with HbS/beta-thal, high circulating periostin showed weak correlation with LDH (r=0.262, p=0.023). Regarding BMD, osteoporosis (according to the WHO definition based on DXA data) was present in 45% of patients with TM, in 40% of patients with TI, in 33% of SCD patients and in 25% of patients with HbS/beta-thal. Interestingly, high periostin levels strongly correlated with high BMD T-score of L1-L4 in HbS/beta-thal patients (r=0.740, p=0.006), but there were no other correlations between circulating periostin with BMD in the other subtypes of hemoglobinopathies.Our data, the first in the literature on circulating periostin levels in patients with hemoglobinopathies, show that periostin is elevated in the serum of patients with all studied subtypes of hemoglobinopathies, but it correlates with high BMD only in patients with HbS/beta-thal. One possible explanation is that periostin correlates with bone repair and possibly patients with HbS/beta-thal have higher repair activity and thus lower bone loss, increased bone strength and lower incidence of osteoporosis compared to other hemoglobinopathies patients. Furthermore, the presence of different periostin isoforms with unknown activity on bone remodeling may also explain these differences. Further studies are necessary to understand the regulation of periostin and its biological activities in the bone of patients with hemoglobinopathies. Disclosures:No relevant conflicts of interest to declare.

Protective effects of ginkgo biloba extract on ligature-induced periodontitis in rats

Objective. The aim of this study was to test the hypothesis that the systemic administration of extract of Ginkgo biloba (EGb) would prevent excessive tissue destruction in ligature-induced periodontitis in a rat model. Materials and methods. Thirty-two male Wistar albino rats were used in the current study. The rats were randomly divided into four groups of eight rats each: (1) non-ligated treatment (NL) group, (2) ligature-only (LO) group, (3) ligature plus GB28 (28 mg/kg, daily for 11 days) group and (4) ligature plus GB56 (56 mg/kg, daily for 11 days) group. Results. Measurement of alveolar bone loss in the mandibular molar tooth revealed significantly lower bone loss values in the LO group compared to groups NL, GB28 and GB56 (p < 0.05). Conclusion. The present results are the first data which suggests that host response in periodontitis can be modified by EGb administration. EGb minimized progression of periodontal disease.

Influence of mini-implant length on crestal bone loss: A one-year follow-up

Context: Implant geometry is reported to be one of the several factors that influence bone loss. Aims: This study aimed to evaluate the effect of the length of mini-implants on radiographic bone loss measured mesially and distally. Materials and Methods: Twelve patients (four male and eight female), with a mean age of 21.6 years (range, 16-38), were included in this study. All selected patients had bilateral congenital missing maxillary lateral incisors. Each patient received two implants (Narrow ridge, MS, Osstem, Korea), which were fitted in limited interdental space cases and immediately loaded. The implants were divided randomly into two groups. Twelve 10-mm-long implants and twelve 13-mm-long implants were inserted. Bone loss measurements were obtained from the images of successive traditional radiographs, which were previously scanned and digitized, analyzed at 800% magnification. Statistical analysis was performed to assess the mean marginal bone loss at 12 months as well as to explore the potential effect of implant length on bone loss. Statistical Analysis Used: Chi-square analysis was used to compare the means. Results: The mean crestal bone loss in the group that received 10-mm implants was 1.36 (0.45) mm mesially and 1.55 (0.32) mm distally, while in the 13-mm group it was 0.71 (0.27) mm and 0.61 (0.35) mm, respectively; this demonstrated a significantly lower bone loss at 12 months on the mesial as well as distal side in the latter group. Conclusions: Within the limitations of the present study, we identified a negative correlation between mini-implant length and bone loss.

Treatment of experimental periodontal disease with antimicrobial photodynamic therapy in nicotine‐modified rats

The aim of this study was to compare antimicrobial photodynamic therapy (aPDT) as an adjunctive treatment to scaling and root planing (SRP) for induced periodontitis in nicotine-modified rats. A total of 240 rats were evenly divided into two groups: C - saline solution treatment; N - nicotine treatment. Periodontal disease was induced in both groups at the first mandibular molar. After 7days, the ligature was removed. All animals were submitted to SRP and were divided according to the following treatments: SRP - irrigation with saline solution; Toluidine Blue-O (TBO) - irrigation with phenothiazinium dye (100μg/ml); LLLT - laser irradiation (660nm; 0.03W; 4J); and aPDT - TBO and laser irradiation. Ten animals in each group/treatment were euthanized at 7, 15 and 30days. The histometric and immunohistochemical values were statistically analysed. Intragroup analysis demonstrated that in both groups the aPDT treatment resulted in lower bone loss (BL) when compared to SRP in all experimental periods. Intergroup analysis demonstrated that aPDT treatment resulted in lower BL in Group N than in Group C treated with SRP in all experimental periods. Antimicrobial photodynamic therapy was an effective adjunctive treatment to SRP for induced periodontitis in nicotine-modified rats.

Association Between Changes in Habitual Physical Activity and Changes in Bone Density, Muscle Strength, and Functional Performance in Elderly Men and Women

To investigate the long-term effects of habitual physical activity on changes in musculoskeletal health, functional performance, and fracture risk in elderly men and women. Ten-year prospective population-based study. Malmö-Sjöbo Prospective Study, Sweden. Participants were 152 men and 206 women aged 50, 60, 70, and 80 who were followed for 10 years. Distal radius bone mineral density (BMD) (single photon absorptiometry), upper limb muscle (grip) strength, balance, gait velocity, occupational and leisure-time activity, and fractures (interview-administered questionnaire) were reassessed after 10 years. Annual changes for all measures were compared between participants with varying habitual physical activity histories at baseline and follow-up: inactive-inactive (n=202), active-inactive (n=47), inactive-active (n=49), and active-active (n=60). Data for men and women were pooled, because there were no sex-by-activity group interactions. To detect possible differences in fracture incidence between the varying habitual activity groups, participants were classified into two activity groups based on their activity classification at baseline and follow-up: inactive:less active versus active:more active. The annual rate of bone loss was 0.6% per year less in individuals classified as active at both time points than in those classified as inactive at both time points (P<.01). Similar results were observed for balance, but there was no effect of varying habitual activity on changes in muscle strength or gait velocity. There were also no differences in fracture incidence between individuals categorized as active:more active and those categorized as inactive:less active during the follow-up (adjusted hazard ratio=0.90, 95% confidence interval (CI)=0.42-1.90). This study showed that elderly men and women who maintained a habitually active lifestyle over 10 years had lower bone loss and retained better balance than those who remained habitually inactive.

Age-Dependent Associations Between Chronic Periodontitis/Edentulism and Risk of Coronary Heart Disease

Several epidemiological studies have suggested periodontitis as a risk factor for coronary heart disease (CHD), but results have been inconsistent. We evaluated the association between clinical and radiographic measures of periodontitis, edentulism, and incident CHD (angina, myocardial infarction, or fatal CHD) among 1203 men in the VA Normative Aging and Dental Longitudinal Studies who were followed up with triennial comprehensive medical and dental examinations up to 35 years (median 24 years). Cox proportional hazards models with time-varying effects of exposure and potential confounders were fit. We found a significant dose-dependent association between periodontitis and CHD incidence among men < 60 years of age (hazard ratio 2.12, 95% confidence interval 1.26 to 3.60 comparing highest versus lowest category of radiographic bone loss, P for trend=0.02), independent of age, body mass index, smoking, alcohol intake, diabetes mellitus, fasting glucose, total cholesterol, high-density lipoprotein cholesterol, triglycerides, hypertension, systolic and diastolic blood pressure, education, marital status, income, and occupation. No association was found among men > 60 years of age. Similar results were found when the sum of probing pocket depths was used as a measure of periodontitis. Among men > or = 60 years of age, edentulous men tended to have a higher risk of CHD than dentate men in the lowest bone loss (hazard ratio 1.61, 95% confidence interval 0.95 to 2.73) and lowest pocket depth (hazard ratio 1.72, 95% confidence interval 1.03 to 2.85) categories, independent of confounders. Chronic periodontitis is associated with incidence of CHD among younger men, independent of established cardiovascular risk factors.

The acid-base hypothesis: diet and bone in the Framingham Osteoporosis Study

There continues to be considerable debate about the role of acid vs. basic components of the diet on the long-term status of bone mineral density. In a set of two analyses, we examined the effect of components in the diet thought to have basic effects (magnesium, potassium, fruit, vegetables) and acid effects (protein) on bone mineral density in an elderly cohort. Bone mineral density of participants in the Framingham Osteoporosis Study was measured at three hip sites and one forearm site at two points in time, four years apart. At the time of baseline measurement, participants ranged in age from 69-97 years. Dietary intake was assessed at baseline by food frequency questionnaire. As hypothesized, magnesium, potassium, fruit and vegetable intakes were significantly associated with bone mineral density at baseline and among men, with lower bone loss over four years. In contrast to the hypothesis, higher rather than lower protein intakes were associated with lower bone loss. Together these results support the role of base forming foods and nutrients in bone maintenance. The role of protein appears to be complex and is probably dependent on the presence of other nutrients available in a mixed diet. A balanced diet with ample fruit and vegetables and adequate protein appears to be important to bone mineral density.