Periodontal Disease, Bone Loss, and Anti-Androgen Therapy

Periodontitis is a multifactorial disease with microbial dental plaque as the etiological agent. The manifestation and progress of periodontitis is influenced by a wide variety of determinants and factors, including subject characteristics, social and behavioral factors, systemic factors, genetic factors, the microbial composition of dental plaque, and others. The pathogenesis of periodontal disease results in resorption of alveolar bone and loss of the attachment apparatus to the teeth. There is a biological potential that periodontal destruction may be influenced by systemic bone loss. Since alveolar bone loss is a prominent feature of periodontal disease, disturbances in bone mineral density (BMD), especially in the jaws, are suspected of being an aggravating factor in periodontal disease. In previously published research, the severity of osteoporosis may be related to tooth loss in post-menopausal women. Considering the relationship among bone mineral density, osteoporosis, and periodontitis in men, it is known that men completing androgen ablation therapy for control of prostate cancer are at higher risk for osteoporosis. As androgen deprivation therapy is the recommended treatment for men with metastatic or locally-advanced nonmetastatic prostate carcinoma, and as prostate carcinoma is the most common visceral malignancy and the second leading cause of death from cancer in men, the relationship between androgen deprivation therapy and loss of bone mineral density is a matter of public health importance.This dissertation assesses the association between bone mineral density, the presence of periodontal disease, and the possible subsequent onset of clinical osteoporosis, as seen among a population of older women followed longitudinally; a set of men with prostate carcinoma undergoing androgen ablation therapy; and those men in the same set not receiving androgen ablation for prostate cancer. We believe our research, using the model of periodontal bone density and oral bone loss, shows additional clear empirical evidence pointing to a cause-and-effect relationship between androgen deprivation therapy and loss of bone mineral density