Periodontal Disease and Osteoporosis: A Bidirectional Relationship

Osteoporosis (OP) and periodontitis (PD) are two prevalent diseases with significant public health implications, particularly among aging populations. Osteoporosis is a condition that can affect any bone, characterized by decreased bone mineral density (BMD) and deterioration of the bone architecture, resulting in weaker bones and a higher risk of fractures. Periodontitis is a chronic inflammatory condition affecting the supporting structures of the teeth, such as the gingiva, periodontal ligament, and alveolar bone, often leading to tooth loss if left untreated. Recent studies have suggested an interrelationship between these conditions, rooted in shared biological mechanisms. Both diseases involve an imbalance in bone remodeling processes, with excessive activity of osteoclasts over osteoblasts, leading to bone resorption. In osteoporosis, this imbalance is systemic, while in periodontitis, it is localized to the jawbone. Shared risk factors, such as aging, hormonal changes (e.g., postmenopausal estrogen deficiency), and lifestyle factors, like smoking and poor nutrition, further strengthen this association. Additionally, osteoporosis may exacerbate periodontitis by reducing alveolar bone density, while periodontal inflammation can elevate the expression of systemic biomarkers of bone resorption, influencing osteoporosis progression. Furthermore, dysbiosis of the gut and oral cavity microbial communities plays a critical role in both conditions. Gut dysbiosis can influence systemic inflammation and bone metabolism, exacerbating osteoporosis, while oral dysbiosis, marked by pathogenic shifts in the microbiota, triggers and perpetuates periodontal inflammation and alveolar bone loss. Understanding these interrelationships emphasizes the need for an integrated approach to preventing and managing these interconnected conditions.