Association between dietary patterns and periodontal disease: The OsteoPerio cohort study.

AIM: To examine the association of dietary patterns with periodontal disease (PD) and its progression over 5 years. MATERIALS AND METHODS: Analyses involved 1197 post-menopausal women from the OsteoPerio cohort. Dietary patterns assessed include Healthy Eating Index-2015 (HEI), Alternative HEI (AHEI), Dietary Approaches to Stop Hypertension (DASH) and alternate Mediterranean Diet (aMed) at baseline (the average of two food frequency questionnaires administered between 1993 and 2001). At baseline and the 5-year follow-up, periodontal assessments evaluated alveolar crestal height (ACH), probing pocket depth (PPD), clinical attachment loss (CAL), percentage of gingival sites bleeding on probing (%BOP) and missing teeth due to PD. Linear and logistic regression were used to examine the associations. RESULTS: Cross-sectionally, HEI and aMed were associated with smaller CAL and %BOP; along with DASH, they were associated with a decreased odds of teeth missing due to PD. AHEI and aMed were associated with a decreased odds of severe PD. Prospectively, AHEI was associated with greater ACH progression. This association was attenuated to the null after loss of ACH was imputed for teeth lost due to PD over follow-up, or after excluding participants with diabetes, osteoporosis, hypertension or heart disease at baseline. CONCLUSIONS: Better adherence to healthy dietary patterns was associated with better PD measures cross-sectionally but greater progression of ACH over 5 years. The latter might be explained by incident tooth loss due to PD and pre-existing comorbidities.

Postmenopausal women with HIV have increased tooth loss.

BACKGROUND: With effective antiretroviral therapy, people with HIV (PWH) are living longer and aging; the majority of PWH in the United States are now over the age of 50 and in women have gone through the menopause transition. Menopause potentiates skeletal bone loss at the spine, hip, and radius in PWH. The alveolar bone which surronds the teeth is different than long bones because it is derived from the neural crest. However, few studies have assessed the oral health and alveolar bone in middle aged and older women with HIV. Therefore, the objective of this study was to evaluate periodontal disease and alveolar bone microarchitecture in postmenopausal women with HIV. METHODS: 135 self-reported postmenopausal women were recruited (59 HIV-, 76 HIV + on combination antiretroviral therapy with virological suppression) from a single academic center. The following parameters were measured: cytokine levels (IFN-γ, TNF-α, IL-1ß, IL-2, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12p70, IL-13, IL-17 A, OPG, and RANKL) in gingival crevicular fluid, bleeding on probing, probing depth, clinical attachment loss, number of teeth present, alveolar crestal height, and alveolar bone microarchitecture. RESULTS: The mean age of participants was 57.04+/-6.25 years and a greater proportion of women with HIV were black/African American (HIV + 68.42%, HIV- 23.73%; p < 0.001). There was no significant difference in bleeding on probing (p = 0.17) and attachment loss (p = 0.39) between women who were HIV infected vs. HIV uninfected. Women with HIV had significantly higher RANKL expression in Gingival Crevicular Fluid (HIV + 3.80+/-3.19 pg/ul, HIV- 1.29+/-2.14 pg/ul ; p < 0.001), fewer teeth present (HIV + 17.75+/-7.62, HIV- 22.79+/-5.70; p < 0.001), ), lower trabecular number (HIV + 0.08+/-0.01, HIV- 0.09+/-0.02; p = 0.004) and greater trabecular separation (HIV + 9.23+/-3.11, HIV- 7.99+/-3.23; p = 0.04) compared to women without HIV that remained significant in multivariate logistic regression analysis in a sub-cohort after adjusting for age, race/ethnicity, smoking status, and diabetes. CONCLUSION: Postmenopausal women with HIV have deterioration of the alveolar trabecular bone microarchitecture that may contribute to greater tooth loss.

Digital panoramic radiography and CBCT as auxiliary tools for detection of low bone mineral density in post-menopausal women: a cross-sectional study.

BACKGROUND: Osteoporosis is a chronic, multifactorial skeletal disease that occurs especially in women following a decrease in estrogen levels and decrease in bone mineral density. The aim of this study was to evaluate the relationship between qualitative and quantitative indexes in panoramic radiographs and quantitative indexes in CBCT images with femoral and vertebral BMD in postmenopausal women. METHODS: This comparative cross-sectional study was performed on postmenopausal women aging 40 to 80 years attending for obtaining either panoramic radiograph or mandibular CBCT scan. Dual energy X-ray absorptiometry (DEXA) was performed from the femur and lumbar vertebra. Quantitative parameters of mental index (MI), panoramic mandibular index (PMI), antegonial index (AI) as well as qualitative parameters of mandibular cortical index (MCI) and trabecular bone pattern (TP) were evaluated in panoramic radiographs. Quantitative parameters computed tomography mandibular index (CTMI), computed tomography index (inferior) [CTI(I)] and computed tomography index (superior) [CTI(S)] were analyzed in CBCT images. Kolmogorov-Smirnov tests and Pearson correlation coefficient were used (α = 0.05). RESULTS: In individuals with panoramic radiography, statistically significant correlations were observed between MI with vertebral and femoral T-score, AI with vertebral and femoral T-score (except for the right AI with femoral T-score), and TP with vertebral and femoral T-score (p < 0.05). In the group with CBCT scans, the correlations between CTMI with vertebral and femoral T-score, CTI(I) with vertebral and femoral T-score, and CTI(S) with vertebral and femoral T-score were statistically significant (p < 0.05). CONCLUSIONS: in CBCT images, quantitative indexes of CTMI, CTI(I), and CTI(S), and in panoramic images, quantitative indexes of MI and AI and qualitative index of TP can be used to predict the possibility of osteoporosis in postmenopausal women.

Oral Disorders and Serum Oestrogen Levels in Postmenopausal Women in Lagos, Nigeria.

BACKGROUND: Changes in hormonal levels during puberty, pregnancy, menstruation, and menopause have varying effects on the oral cavity. Several mucosal disorders manifest in the oral cavity of postmenopausal women partly due to a decrease in oestrogen and progesterone level which are significant. The aim of this study was to determine the oral disorders associated with serum blood oestrogen levels in Nigerian postmenopausal women. MATERIALS AND METHODS: A cross-sectional analytical study at the Oral Diagnosis and Oral Medicine clinics in a large tertiary hospital in Lagos, Nigeria between June 2019 and December 2019 involving 35 postmenopausal and 35 premenopausal women within the ages of 40 to 60 years. The prevalence of oral disorders such as hyposalivation, burning mouth sensation, and periodontitis in pre and postmenopausal women was determined, likewise the association between oral disorders and blood oestrogen levels. RESULTS: The mean age of the postmenopausal women was 53.2 ± 5.6 years and premenopausal women was 46.4 ± 4.0 years. Chronic periodontitis was the most prevalent oral disorder in 19(54.3%) postmenopausal women followed by hyposalivation 5(14.3%) compared with 13(37.1%) and 2(5.7%) respectively in premenopausal women. All postmenopausal women who had chronic periodontitis 19(100%) had relatively high oestradiol levels compared with 5(38.5%) premenopausal women. CONCLUSION: There was no statistically significant association between oral disorders and blood oestrogen levels.

CONTEXTE: Les changements des niveaux hormonaux pendant lapuberté, la grossesse, la menstruation et la ménopause ont des effets variables sur la cavité buccale. Plusieurs troubles des muqueuses se manifestent dans la cavité buccale des femmes ménopausées, en partie à cause d'une baisse significative des taux d'œstrogènes et de progestérone. L'objectif de cette étude était de déterminer les troubles bucco-dentaires associés aux niveaux d'œstrogènes dans le sang sérique chez les femmes ménopausées nigérianes. MATÉRIEL ET MÉTHODES: Une étude analytique transversale dans les cliniques de diagnostic oral et de médecine bucco-dentaire d'un grand hôpital tertiaire à Lagos, au Nigeria, entre juin 2019 et décembre 2019, impliquant 35 femmes ménopausées et 35 femmes préménopausées âgées de 40 à 60 ans. La prévalence des troubles bucco-dentaires tels que l'hyposalivation, la sensation de bouche brûlante et la parodontite chez les femmes pré et post-ménopausées a été déterminée, de même que l'association entre les troubles buccodentaires et les niveaux d'œstrogènes dans le sang. RÉSULTATS: L'âge moyen des femmes ménopausées était de 53,2 ± 5,6 ans et celui des femmes préménopausées de 46,4 ± 4,0 ans. La parodontite chronique était le trouble bucco-dentaire le plus répandu chez 19 (54,3 %) femmes ménopausées, suivie par l'hyposalivation 5 (14,3 %), contre 13 (37,1 %) et 2 (5,7 %) respectivement chez les femmes préménopausées. Toutes les femmes ménopausées qui souffraient de parodontite chronique 19(100%) avaient des taux d'œstradiol relativement élevés par rapport à 5(38,5%) femmes préménopausées. CONCLUSION: Il n'y a pas d'association statistiquement significative entre les troubles bucco-dentaires et les taux d'œstrogènes dans le sang.

Association of pentosidine and homocysteine levels with number of teeth present in Japanese postmenopausal women.

INTRODUCTION: Little is known about whether substances inducing tissue protein degeneration in the oral cavity are associated with the number of teeth present in postmenopausal women. We sought to investigate the association of urinary pentosidine and serum homocysteine levels with the number of teeth and subsequent tooth loss in Japanese postmenopausal women. MATERIALS AND METHODS: Among participants in the Nagano Cohort Study, 785 postmenopausal women (mean age, 68.1 years) participated in the present study. The number of teeth was re-counted at the time of follow-up in 610 women. Poisson regression analysis was used to investigate differences in the number of teeth among quartiles of pentosidine or homocysteine, adjusting for covariates that correlated with the number of teeth. A Cox proportional hazard model was used to evaluate the association of subsequent tooth loss with pentosidine or homocysteine levels. RESULTS: Pentosidine quartiles were not associated with the number of teeth at baseline. Participants in the highest homocysteine quartile had significantly fewer teeth at baseline than those in the third and lowest quartiles (p < 0.001 for both). Those in the second quartile had fewer teeth than those in the third (p = 0.001) and lowest (p < 0.001) quartiles. An increased risk of tooth loss during follow-up was significantly associated with higher urinary pentosidine (hazard ratio = 1.073 for 10 pmol/mgCre; p = 0.001). CONCLUSION: Postmenopausal women with higher homocysteine levels had fewer teeth at baseline. A higher pentosidine concentration increased the risk of subsequent tooth loss. High pentosidine or homocysteine concentrations may be associated with tooth loss in postmenopausal women.

High serum iron markers are associated with periodontitis in post-menopausal women: A population-based study (NHANES III).

AIM: To investigate the association between increased serum markers of iron (ferritin and transferrin saturation) and the severity and extent of periodontitis in post-menopausal (PM) women. MATERIALS AND METHODS: Data from 982 PM women participating in NHANES III were analysed. Exposures were high ferritin (≥300 µg/ml) and transferrin saturation (≥45%). The primary outcome was moderate/severe periodontitis defined according to Centers for Disease Control and Prevention and the American Academy of Periodontology. The extent of periodontitis was also assessed as outcome: proportion of sites affected by clinical attachment loss ≥4 mm and probing depth ≥4 mm. Crude and adjusted prevalence ratio (PR) and mean ratio (MR) were estimated using Poisson regression. RESULTS: The prevalence of moderate/severe periodontitis was 27.56%. High ferritin was associated with moderate/severe periodontitis in the crude (PR 1.55, p = .018) and in the final adjusted model (PR 1.53, p = .008). High ferritin and transferrin saturation levels were associated with a higher proportion of sites with clinical attachment loss ≥4 mm (p < .05). CONCLUSIONS: The increasing serum iron markers seem to contribute to periodontitis severity and extent in PM women.

Functional and psychological evaluation of premenopausal and postmenopausal women after provision of a complete denture prosthesis.

STATEMENT OF PROBLEM: Clinical studies regarding satisfaction and occlusal forces with the complete denture in relation to the menopause are sparse. PURPOSE: The purpose of this clinical study was to compare satisfaction levels and occlusal force with complete dentures in premenopausal and postmenopausal Indian women. MATERIAL AND METHODS: Twenty premenopausal (group pre-MP) and 20 postmenopausal (group post-MP) completely edentulous participants were selected based on inclusion and exclusion criteria, and estradiol levels were measured. Complete dentures were delivered to all participants following standard fabrication and insertion protocols. Three months after denture insertion, when participants were free of postinsertion complaints, satisfaction level (by using a valid and reliable questionnaire), depression level by using the Patient Health Questionnaire, (PHQ-9) and occlusal force (with a gnathodynamometer) were measured. The obtained data of all parameters were tabulated and compared by using a statistical software program (α=.05). RESULTS: For questions pertaining to the overall satisfaction of maxillary and mandibular dentures, the 2 study groups encountered a significant difference with the premenopausal group showing significantly higher satisfaction levels (P<.001). Depression scores in the postmenopausal women group were significantly higher than those of the premenopausal women group (P<.001). A negative correlation was found between the overall satisfaction with complete dentures and depression levels in the participants indicating decreased overall satisfaction with increasing depression levels in participants (rho=-0.698). The premenopausal group recorded significantly higher estradiol levels than the postmenopausal group (P<.001). Mean occlusal force with complete dentures in the premenopausal women group was significantly higher than that of the postmenopausal women group (P<.001). A positive correlation was found between the estradiol levels and occlusal forces in the participants indicating that with decreasing estradiol levels, the occlusal forces decrease in the participants (r=0.740). CONCLUSION: Satisfaction levels and occlusal force with complete dentures were significantly higher in premenopausal women group than in the postmenopausal group.

Venlafaxine vs. fluoxetine in postmenopausal women with major depressive disorder: an 8-week, randomized, single-blind, active-controlled study.

BACKGROUND: In the population of postmenopausal patients with major depressive disorder (MDD), the superiority of serotonin-norepinephrine reuptake inhibitors (SNRIs) over selective serotonin reuptake inhibitors (SSRIs) has not yet been definitively proven. Consequently, a direct comparison of the efficacy of SSRIs and SNRIs in the treatment of postmenopausal depression could provide relevant data. The aim of this study was to compare the efficacy and safety of venlafaxine vs. fluoxetine in the treatment of postmenopausal MDD. METHODS: This was an 8-week, multicenter, randomized, single-blind, active-controlled trial conducted at a psychiatric hospital (Beijing Anding Hospital) and a general hospital (Beijing Chaoyang Hospital) between April 2013 and September 2017. The primary outcome measure was improving depressive symptoms (Hamilton Depression Rating Scale (HAMD-24) score). The secondary outcomes included the change of HAMD-24 anxiety/somatization factor score and Clinical Global Impressions-Improvement (CGI-I) response rate. Safety was assessed by treatment-emergent adverse events (TEAEs) and laboratory tests. Efficacy was analyzed by using the full analysis set (FAS) following the modified intention-to-treat (mITT) principle. The primary endpoint measurements were analyzed using a mixed-effect model for repeated measures (MMRM) model with patients as a random-effect factor, treatment group as the independent variable, time as a repeated measure, and baseline covariates, using a first-order ante dependence covariance matrix. RESULTS: A total of 184 women were randomized. The full analysis set (FAS) included 172 patients (venlafaxine, n = 82; fluoxetine, n = 90). Over the 8-week study period, the reduction in HAMD-24 scores was significant (P < 0.001) in both groups, while a significantly greater decline from baseline was observed in the venlafaxine group compared with the fluoxetine group (least-squares mean difference [95% CI]: - 2.22 [- 7.08, - 0.41]), P = 0.001). The baseline-to-week-8 least-squares mean change of the anxiety/somatization factor scores, CGI-I response rate were greater in the venlafaxine group than in the fluoxetine group (all P < 0.05). The most frequent TEAEs (≥5%) in both groups were nausea, somnolence, dizziness, headache, and dry mouth. There was no significant difference in the incidence of adverse events between the two groups. CONCLUSION: Venlafaxine was well tolerated and compared to fluoxetine, it led to a greater improvement in the treatment of postmenopausal MDD. TRIAL REGISTRATION: Clinical Trials. gov #NCT01824433 . The trial was registered on April 4, 2013.

Local treatment with a polycarbophil-based cream in postmenopausal women with genitourinary syndrome of menopause.

INTRODUCTION AND HYPOTHESIS: Genitourinary syndrome of menopause (GSM) is a common problem associated with lower urinary tract and gynecological symptoms due to the decrease in estrogen production in postmenopausal women. Topical estrogen therapy is shown to improve these symptoms; nonetheless, there are limited data on the efficacy of nonhormonal moisturizers in these patients. METHODS: A prospective cohort study was conducted to compare the symptoms of GSM before and after treatment with a polycarbophil-based cream in 42 women. The quality of life (QoL) and sexual scores were obtained from the Thai version of the International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms (ICIQ-LUTS) along with uroflow measurements before and 4 and 12 weeks after treatment. RESULTS: Significant improvements in ICIQ-LUTSqol scores were observed after 4 weeks (9.38 ± 7.47 vs 6.76 ± 5.77; p = 0.017) and 12 weeks (10.03 ± 7.49 vs 5.97 ± 4.02; p = 0.002) when compared with the baseline values before treatment. The ICIQ-LUTS sexual scores were also improved after treatment at 4 weeks (2.29 ± 2.26 vs 0.88 ± 1.34; p < 0.001) and 12 weeks (2.13 ± 2.22 vs 0.42 ± 0.81; p < 0.001) compared with the baseline scores. No differences in ICIQ-LUTSqol and sexual scores were observed between the 4- and 12-week treatment groups. CONCLUSION: The polycarbophil-based cream improved the overall LUTS and sexual symptoms in the patients with GSM, thus indicating that the nonhormonal polycarbophil-based cream may prove effective for the treatment for women with this condition.

Salivary Content Might be Associated With Skeletal Status in Postmenopausal Women: SilesiaOsteoActive Study Results.

AIM: The aim of the study was to investigate whether salivary mineral content may be associated with bone status in women after menopause. MATERIAL AND METHODS: The study group consisted of 125 postmenopausal women aged 64.3 ± 6.9 yr, derived from the epidemiological SilesiaOsteoActive Study. All participants underwent hip and spine bone densitometry using dual energy X-ray absorptiometry, dental examination, and saliva content analysis. Data for salivary pH, copper, calcium, phosphorus, and zinc concentrations were evaluated. RESULTS: Mean femoral neck bone mineral density (BMD) was 0.739 ± 0.118 g/cm2, total hip BMD 0.891 ± 0.14 g/cm2, and spine BMD 0.868 ± 0.14 g/cm2. Salivary pH was significantly lower in women with spinal osteoporosis defined as T-score below -2.5, compared to individuals with normal BMD (pH: 6.65 ± 0.67 vs 6.96 ± 0.58, p < 0.05). There was a significant though weak inverse correlation between Ca concentration in saliva and femoral neck BMD (r = -0.23, p < 0.05). CONCLUSIONS: High salivary calcium content and low salivary pH may be indicative of low hip and decreased spine BMD, respectively. These associations may reflect demineralization process (calcium redistribution) influencing bone, and a negative effect of acidity on mineral tissues, although causal pathway remains not clear.

Oral health and emotional well-being in premenopausal and postmenopausal women: a cross-sectional cohort study.

BACKGROUND: Menopause, the absence of ovarian sex steroids, is frequently accompanied by emotional and physiological changes in a woman´s body, as well as oral health changes. The present study aimed to evaluate the association between the periodontal health status and emotional and physical well-being among postmenopausal women (PMW) in comparison with regularly menstruating premenopausal women (RMPW). METHODS: A total of 115 women (PMW, n = 56, mean age ± SD: 54 ± 5; RMPW, n = 59, mean age ± SD: 41 ± 4) received a comprehensive medical assessment and a full-mouth oral examination. All completed the Women's Health Questionnaire (WHQ) to measure emotional and physical well-being. The corresponding bone mineral density (BMD) scores were obtained from participants´ medical records. RESULTS: Tooth loss was significantly higher in PMW than RMPW after adjusting for age (3.88 ± 2.41 vs 2.14 ± 2.43, p < 0.05). No significant difference was found in the prevalence of periodontitis between the two groups (PMW: 39.2%, RMPW: 32.2%, p > 0.05). The prevalence of periodontitis was associated with fewer daily brushing sessions in PMW (p = 0.021). Based on the WHQ, both PMW and RMPW with periodontitis had higher ''depressed mood'' scores compared to periodontally healthy women (p = 0.06 and p = 0.038, respectively). The women who reported fewer daily toothbrushing sessions found to have higher depressive mood scores (p = 0.043). CONCLUSIONS: Presence of periodontitis is associated with the emotional and physical well-being of women and reinforcement of oral healtcare is recommended at different stages of a woman's life including menopause to reduce the risk for early tooth loss in women.

A 5-year longitudinal association between dietary fermented soya bean (natto) intake and tooth loss through bone mineral density in postmenopausal women: The Yokogoshi cohort study.

OBJECTIVE: In this 5-year cohort study, we aimed to determine whether the intake of natto, a fermented soya bean food product, has an indirect effect on tooth loss incidence through BMD changes among postmenopausal women. BACKGROUND: Evidence indicates (1) that natto has a beneficial effect on bone health and (2) that a decrease in bone mineral density (BMD) is associated with tooth loss. METHODS: The study recruited 435 postmenopausal women (average age = 64.2 years). Natto intake (exposure) was assessed at baseline using a food frequency questionnaire. Lumbar spine BMD and number of teeth were measured at baseline and 5-year follow-up. BMD change (mediator) and the number of teeth lost (outcome) over time were calculated. The mediation model consisted of these 3 variables. Mediation analysis was performed to test the indirect effect of the natto intake measured through BMD change on tooth loss. RESULTS: During the study, the mean number of teeth lost was 1.2 (standard deviation = 1.8), and the mean BMD decline was 2.5% (standard deviation = 7.1). After adjusting for potential confounders, increasing habitual natto intake was significantly indirectly associated with a lower incidence of tooth loss mediated by BMD change (incidence rate ratio of tooth loss among women with "≥1 pack/day" natto intake was 0.90 [95% confidence interval = 0.82-0.99] compared to those with natto consumption of "rarely"). CONCLUSIONS: Dietary natto intake is significantly indirectly associated with a lower incidence of tooth loss among postmenopausal women, and systemic bone density could be a mediator of this association.

Role of hormone replacement therapy in relieving oral dryness symptoms in postmenopausal women: a case control study.

BACKGROUND: To evaluate the efficacy of hormone replacement therapy in relieving oral symptoms in postmenopausal women presenting with genitourinary symptoms along with oral dryness. METHODS: A case-control study was conducted after selecting 60 postmenopausal women. Oral dryness status of all the patients was evaluated with the help of questionnaire related to oral dryness. These subjects were divided into case group and control group on the basis of response to questionnaire of oral dryness. Unstimulated saliva samples were obtained and analyzed for estimation of salivary estradiol levels by enzyme linked immune sorbent assay technique. After analyzing the result of salivary estradiol levels, case group was subjected to hormone replacement therapy (HRT). The patients were followed up for their response towards oral dryness as well as salivary estradiol levels after the therapy. RESULTS: The mean salivary estradiol level before HRT was significantly more among control group as compared to case group (p value < 0.001). Most of the patients complained of dry mouth (26 out of 30); reduced amount of saliva in the mouth (25 out of 30); dry mouth at night (28 out of 30); dry mouth during the day (25 out of 30) before HRT. These complains were significantly reduced after the therapy. The mean salivary estradiol in the case group levels increased significantly after HRT (p value < 0.001). CONCLUSION: The salivary estradiol levels were reduced in post menopausal women with the complain of xerostomia as compared to those without the complain of xerostomia. Further these levels can be recovered with the help of hormone replacement therapy.

[Clinical parameters of the oral cavity in postmenopausal women during the course of a nonsteroidal anti-inflammatory drug]. / Klinicheskie parametry sostoyaniya polosti rta u zhenshchin postmenopauzal'nogo perioda pri kursovom primenenii nesteroidnogo protivovospalitel'nogo preparata.

THE AIM OF THE STUDY: Was to assess the clinical effectiveness of the course of ketoprofen lysine salt after its oral application in postmenopausal women with vitamin D deficiency in the complex therapy of inflammatory periodontal diseases. MATERIALS AND METHODS: The study comprised 100 women with decreased bone mineral density and chronic generalized mild to moderate periodontitis. The average age was 55.3±1.9 years with menopause lasting for more than 5 years (6.0±0.8) and the average age for the onset of menopause of 48.9±1.5 years. The study participants were divided into four groups (two main groups and two comparison groups). The patients underwent periodontal treatments and received native vitamin D prescriptions in accordance with clinical guidelines and treatment protocols. RESULTS: Serum vitamin D for the patents of the first and second groups was 11.4±1.9. Vitamin D level in the comparison groups was 34.6±3.2. The study reveals the direct correlation of chronic periodontitis, the level of bone mineral density and vitamin D deficiency in older female patients. The effects are proved by reduction of indices like PMA, Mulleman bleeding index and periodontal index for all study groups. Correlation of anti-inflammatory activity of the solution with the reduction in pockets depths was 0.46 mm along with improvements in syalometry. Organoleptic properties of the tested oral solution of ketoprofen lysine salt were positively evaluated by all participants, subjective assessments of «color¼, «treatment effect¼ and «prolonged analgesic effect¼ received the highest scores. CONCLUSION: Ketoprofen lysine salt solution has shown significant anti-inflammatory, antioedemic and hemostatic activity of the drug in therapy of chronic generalized mild to moderate periodontitis in older female patients.

Sex hormone replacement therapy in periodontology-A systematic review.

OBJECTIVE: To analyse whether sex hormone replacement therapy (HRT) improves periodontal parameters and dental implants osseointegration in humans. MATERIALS AND METHODS: Electronic databases and hand searches were performed from June to August 2018 in SciELO, LILACS and PubMed/MEDLINE. Human observational and interventional studies that evaluated the following parameters were included: clinical attachment loss (CAL), probing pocket depth (PPD), bleeding on probing (BOP), radiographic bone loss (RBL) or osseointegration. RESULTS: Initial search retrieved 1,282 non-duplicated articles. Fifteen studies were selected after inclusion criteria were applied. All studies were performed in postmenopausal women. Mean differences for PPD reduction ranged from 0.02 to 0.2 mm in HRT-positive patients; mean CAL gain -0.18 to 0.54 mm; mean RBL reduction -0.87 to 0.15 mm; and mean BOP reduction 9%-30.3%. Failure rate of dental implants increased -5.5% to 11.21% when HRT was used. CONCLUSIONS: Very low but consistent evidence suggests a reduction in BOP and no impact on RBL in postmenopausal women receiving HRT. There are inconsistent reports that suggest that HRT in postmenopausal women: (a) improves or does not impact PPD reduction and CAL gain; and (b) does not impact or increase implant loss. In summary, there is no evidence to support HRT prescription for either men or women for periodontal/implant placement purposes.

Royal Jelly-A Traditional and Natural Remedy for Postmenopausal Symptoms and Aging-Related Pathologies.

Women's life stages are based on their reproductive cycle. This cycle begins with menstruation and ends with menopause. Aging is a natural phenomenon that affects all humans, and it is associated with a decrease in the overall function of the organism. In women, aging is related with and starts with menopause. Also, during menopause and postmenopausal period, the risk of various age-related diseases and complaints is higher. For this reason, researchers were pushed to find effective remedies that could promote healthy aging and extended lifespan. Apitherapy is a type of alternative medicine that uses natural products from honeybees, such as honey, propolis, royal jelly, etc. Royal jelly is a natural yellowish-white substance, secreted by both hypopharyngeal and mandibular glands of nurse bees, usually used to feed the queen bees and young worker larvae. Over the centuries, this natural product was considered a gold mine for traditional and natural medicine, due to its miraculous effects. Royal jelly has been used for a long time in commercial medical products. It has been demonstrated to possess a wide range of functional properties, such as: antibacterial, anti-inflammatory, vasodilatative, hypotensive, anticancer, estrogen-like, antihypercholesterolemic, and antioxidant activities. This product is usually used to supplement various diseases such as cardiovascular disease, Alzheimer's disease, sexual dysfunctions, diabetes or cancer. The main objective of this study is to highlight the effectiveness of royal jelly supplementation in relieving menopause symptoms and aging-related diseases. We also aimed to review the most recent research advances regarding the composition of royal jelly for a better understanding of the effects on human health promotion.

Plasma Osteocalcin Levels, Status of Oral Disease and Alteration in Mandibular Bone Density in Postmenopausal Women.

AIM: The present study was undertaken for assessing plasma osteocalcin levels, status of oral disease, and alteration in mandibular bone density in postmenopausal women (PMW). MATERIALS AND METHODS: In all, 80 premenopausal women and 80 PMW were enrolled. For analyzing the oral dryness, clinical score of oral dryness (CSOD) on a scale of up to 10 was used. Complete dental profiling of all the patients was done. Digital panoramic radiographs were taken for all the patients. Bone mineral density (BMD) was evaluated by measuring the following parameters: mandibular cortical index (MCI), panoramic mandibular index (PMI), mandibular cortical width (MCW), and fractal dimension (FD). Osteocalcin levels were evaluated with enzyme-linked immunosorbent assay technique. All the results were recorded and analyzed. RESULTS: Mean osteocalcin levels of PMW (453.12 ng/mL) were significantly higher in comparison to the premenopausal women (249.28 ng/mL). Postmenopausal women had significantly higher CSOD and number of peri-apical radiolucencies in comparison to premenopausal women. Bone mineral density as assessed by MCI was found to be negatively and significantly correlated with oral disease status and osteocalcin levels. Significant difference was obtained while comparing the MCI inbetween the two study groups. CONCLUSION: There is significantly higher prevalence of oral lesions along with oral dryness in postmenopausal women. Also, thinning of mandibular cortex is significantly higher in postmenopausal women. Higher plasma osteocalcin levels help in predicting osteopenia/osteoporosis at an early stage in such patients. CLINICAL SIGNIFICANCE: In PMW, special considerations should be made while planning for dental implant therapy.

Evaluation of long-term dental implant success and marginal bone loss in postmenopausal women.

AIM: The aim of this study was to examine long-term implant success and marginal bone loss (MBL) of dental implants in postmenopausal women with osteoporosis/osteopenia. MATERIALS AND METHODS: Postmenopausal women who underwent dental implant treatment at least 3 years ago were divided into two study groups [Test (osteoporosis/osteopenia) Group and Control Group] according to bone mineral density (BMD) measurements. Besides clinical periodontal and radiographic examinations, any implant failures were also recorded. RESULTS: A total of 52 patients with a mean age of 59.51 ± 5.66 years (Test Group; 26 patients, mean age: 60.61; Control Group; 26 patients, mean age: 58.42) were included in the study. Implant survival rates were 96.2% and 100% with a mean follow-up 60.84 ± 22.13 and 60.07 ± 20.93 months in Test and Control Groups, respectively (P > 0.05). While peri-implant PI (plaque index) and PD (probing depth) were not different between the groups, BoP (bleeding on probing) was significantly higher in Test Group (P = 0,026). Although MBL in Test Group was higher than Control Group (0.82 ± 0,63 mm and 0.44 ± 0,33 mm respectively), the difference was not found statistically significant (P = 0.069). CONCLUSION: Within the limits of this retrospective study, it can be concluded that postmenopausal osteoporosis/osteopenia does not affect MBL and long-term implant success. The findings suggest that dental implant therapy is a reliable treatment modality in these patients to improve the quality of life by increasing function and aesthetics.

Adjuvant denosumab in postmenopausal patients with hormone receptor-positive breast cancer (ABCSG-18): disease-free survival results from a randomised, double-blind, placebo-controlled, phase 3 trial.

BACKGROUND: In postmenopausal women with hormone receptor-positive, early-stage breast cancer, treatment with adjuvant aromatase inhibitors is the standard of care, but it increases risk for osteoporosis and fractures. Results from the ABCSG-18 trial showed that use of denosumab as an adjuvant to aromatase inhibitor therapy significantly reduced clinical fractures. Disease-free survival outcomes from ABCSG-18 have not yet been reported. METHODS: Postmenopausal patients with early, hormone receptor-positive, non-metastatic adenocarcinoma of the breast, who had completed their initial adjuvant treatment pathway (surgery, radiotherapy, or chemotherapy, or a combination) and were receiving adjuvant aromatase inhibitors, were enrolled at 58 trial centres in Austria and Sweden into this prospective, double-blind, placebo-controlled, phase 3 trial. With permuted block randomisation (block sizes 2 and 4, stratified by previous aromatase inhibitor use, total lumbar spine bone mineral density score at baseline, and type of centre), patients were assigned (1:1) to receive subcutaneous denosumab (60 mg) or matching placebo every 6 months during aromatase inhibitor therapy. The primary endpoint (previously reported) was the time to first clinical fracture after randomisation. The secondary endpoint reported here is disease-free survival (defined as time from randomisation to first evidence of local or distant metastasis, contralateral breast cancer, secondary carcinoma, or death from any cause) in the intention-to-treat population. This study is registered with EudraCT (number 2005-005275-15) and ClinicalTrials.gov (number NCT00556374), and is ongoing for long-term follow-up. FINDINGS: Between Dec 18, 2006, and July 22, 2013, 3425 eligible patients were enrolled and randomly assigned; 1711 to the denosumab group and 1709 to the placebo group (with five others withdrawing consent). After a median follow-up of 73 months (IQR 58-95), 240 (14·0%) patients in the denosumab and 287 (16·8%) in the placebo group had disease-free survival events. Disease-free survival was significantly improved in the denosumab group versus the placebo group (hazard ratio 0·82, 95% CI 0·69-0·98, Cox p=0·0260; descriptive analysis, without controlling for multiplicity). In the denosumab group, disease-free survival was 89·2% (95% CI 87·6-90·8) at 5 years and 80·6% (78·1-83·1) at 8 years of follow-up, compared with 87·3% (85·7-89·0) at 5 years and 77·5% (74·8-80·2) and 8 years in the placebo group. No independently adjudicated cases of osteonecrosis of the jaw or confirmed atypical femoral fractures were recorded. The total number of adverse events was similar in the denosumab group (1367 [including 521 serious] adverse events) and the placebo group (1339 [515 serious]). The most common serious adverse events were osteoarthritis (62 [3·6%] of 1709 in the denosumab group vs 58 [3·4%] of 1690 in the placebo group), meniscus injury (23 [1·3%] vs 24 [1·4%]), and cataract (16 [0·9%] vs 28 [1·7%]). One (<0·1%) treatment-related death (due to pneumonia, septic kidney failure, and cardiac decompensation) occurred in the denosumab group. INTERPRETATION: Denosumab constitutes an effective and safe adjuvant treatment for patients with postmenopausal hormone receptor-positive early breast cancer receiving aromatase inhibitor therapy. FUNDING: Amgen.

Loss of alveolar bone density in postmenopausal, osteopenic women is associated with circulating levels of gelatinases.

OBJECTIVE: To determine whether circulating levels of two matrix metalloproteinases, MMP-2 and MMP-9, are associated with loss of alveolar bone density (ABD) or height (ABH), or with progression of periodontitis (relative clinical attachment level [RCAL]), among postmenopausal women with local and systemic bone loss. BACKGROUND: This study was planned as part of a 2-year randomized, double-blind, placebo-controlled, clinical trial examining efficacy/safety of subantimicrobial dose doxycycline (20 mg bid) in postmenopausal osteopenic women. This study examines whether serum levels of gelatinases are associated with local changes in the periodontium. METHODS: A sample of 113 women received periodontal maintenance for moderate to advanced chronic periodontitis and consented to analysis of stored serum biomarkers. Posterior vertical bitewings were taken, and serum collected, at baseline, one, and 2 years. ABD was determined by computer-assisted densitometric image analysis (CADIA), ABH by the Hausmann et al (1992, J Periodontol 63, 657) method, and RCAL by Florida Probe (every 6 months). MMPs were measured densitometrically on gelatin zymograms using denatured type I collagen as substrate and purified MMP-2 (72 kDa) and MMP-9 (92 kDa) as standards. Evidence of worsening in the periodontium at a tooth site was defined as a change from baseline of, for ABD, at least 14 densitometric units (for subcrestal locations) or 17 units (for crestal locations); of at least 0.4 mm for ABH; and of at least 1.5 mm for RCAL. Logistic regression models, while accounting for clustering, compared the odds of worsening in ABD, ABH, or RCAL, after 2 years of observation, between groups defined by baseline and concurrent levels of serum gelatinases. RESULTS: Changes in ABH and RCAL were not associated with circulating levels of MMP-2 or MMP-9. However, elevated odds of ABD loss over 24 months were associated, among smokers, with both baseline and concurrent levels of MMP-9 in the middle and highest tertile, and with concurrent levels of MMP-2 in the middle (but not the highest) tertile. Elevated odds of ABD loss were also associated, among women within 5 years of menopause, with baseline levels of MMP-2 in the highest tertile. CONCLUSION: Among postmenopausal osteopenic women, loss of ABD was associated, in smokers, with elevated circulating levels of MMP-9 and MMP-2. In those within 5 years of menopause, ABD loss was associated with elevated circulating levels of MMP-2.