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Does type 2 diabetic osteoporotic patients present more periodontal risks than non-osteoporotic patients? An evaluation with mandibular cortical index (Klemetti)


Osteoporosis. Diabetes mellitus
type 2. Alveolar bone loss. Periodontitis.

How to Cite

Campos WG de, Montesinos GA, Agudo RCP, Costa K, Munhoz L, Arita ES. Does type 2 diabetic osteoporotic patients present more periodontal risks than non-osteoporotic patients? An evaluation with mandibular cortical index (Klemetti). Braz. J. Oral Sci. [Internet]. 2018 Dec. 11 [cited 2023 Jun. 2];17:e181211. Available from:


Aim: This study aim was to evaluate if patients with type 2 diabetes and osteoporosis have an increased risk of periodontal disease (horizontal and vertical bone loss) when compared to diabetic patients without osteoporosis. Additionally, to assess if patients with diabetes and osteoporosis have a greater risk of reduction of bone mineral density in the mandible, expressed by mandibular cortical index (MCI) when compared to diabetic patients without osteoporosis. Methods: 59 patients (39 diagnosed with type 2 diabetes and osteoporosis; 20 diagnosed with type 2 diabetes and without osteoporosis) were selected. Type 2 diabetes was previously diagnosed by glycated hemoglobin examination and osteoporosis by peripheral dual-energy x-ray absorptiometry. Mandibular cortical index, as well as the presence of vertical and horizontal bone loss was verified on panoramic radiographs. Adjusted odds ratio analyses were performed on presence of periodontal disease and MCI considering the effect of osteoporosis. Results: Absence of statistical significance between variables was found. Conclusions: There is no difference between the risk of periodontal disease or low MCI among osteoporotic and non-osteoporotic type 2 diabetic patients.


Saito M, Kida Y, Kato S, Marumo K. Diabetes, collagen, and bone quality. Curr Osteoporos Rep. 2014 Jun;12(2):181-8. doi: 10.1007/s11914-014-0202-7.

Wongdee K. Update on type 2 diabetes-related osteoporosis. World J Diabetes. 2015 Jun 10;6(5):673-8. doi: 10.4239/wjd.v6.i5.673.

Irani FC, Wassall RR, Preshaw PM. Impact of periodontal status on oral health-related quality of life in patients with and without type 2 diabetes. J Dent. 2015 May;43(5):506-11. doi: 10.1016/j.jdent.2015.03.001.

Chang W-P, Chang W-C, Wu M-S, Pai J-T, Guo Y-C, Chen K-C, et al. Population-Based 5-Year Follow-Up Study in Taiwan of Osteoporosis and Risk of Periodontitis. J Periodontol. 2014 Mar;85(3):e24-30. doi: 10.1902/jop.2013.130256.

Takeshita W, Vessoni Iwaki L, Da Silva M, Tonin R. Evaluation of diagnostic accuracy of conventional and digital periapical radiography, panoramic radiography, and cone-beam computed tomography in the assessment of alveolar bone loss. Contemp Clin Dent. 2014 Jul;5(3):318-23. doi: 10.4103/0976-237X.137930.

Munhoz L, Aoki EM, Cortes ARG, de Freitas CF, Arita ES. Osteoporotic alterations in a group of different ethnicity Brazilian postmenopausal women: An observational study. Gerodontology. 2018 Jun;35(2):101-109. doi: 10.1111/ger.12322.

American Dental Association. Dental radiographic examinations: recommendations for patient selection and limiting radioation exposure. FDA; revised 2012 [cited 2018 May 10]. Available from:

Du Bois AH, Kardachi B, Bartold PM. Is there a role for the use of volumetric cone beam computed tomography in periodontics? Aust Dent J. 2012 Mar;57 Suppl 1:103-8. doi: 10.1111/j.1834-7819.2011.01659.x.

Klemetti E, Kolmakov S, Kröger H. Pantomography in assessment of the osteoporosis risk group. Eur J Oral Sci. 1994 Feb;102(1):68-72.

Pimazoni Netto A, Andriolo A, Fraige Filho F, Tambascia M, Gomes MDB, Melo M, et al. [Update on glycated hemoglobin (HbA1C) for assessment of glycemic control and the diagnosis of diabetes: clinical and laboratory aspects]. Rv Bras Patol Med Lab. 2009 Feb;45(1):31-48. doi: 10.1590/S1676-24442009000100007. Portuguese.

Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int. 1994 Nov;4(6):368-81.

Shapiro SS, Wilk MB. An analysis of variance test for normality (complete samples ). Biometrika. 1965 Dec;52(3):591-611. doi: 10.2307/2333709.

Loe H. Periodontal disease: the sixth complicat diabetes mellitus. Diabetes Care. 1993 Jan;16:329-34. doi: 10.2337/diacare.16.1.329.

Passos JS, Vianna MIP, Gomes-Filho IS, Cruz SS, Barreto ML, Adan L, et al. Osteoporosis/osteopenia as an independent factor associated with periodontitis in postmenopausal women: A case-control study. Osteoporos Int. 2013 Apr;24(4):1275-83. doi: 10.1007/s00198-012-2130-7.

Kushi L, Folsom A, Prineas R, Mink P, Ying W, Bostick R. Postmenopausal women. N Engl J Med. 1996 May;334(18):1156-62.

Munhoz L, Cortes A, Arita E. Assessment of osteoporotic alterations in type 2 diabetes: a retrospective study. Dentomaxillofac Radiol. 2017 Aug;46(6):20160414. doi: 10.1259/dmfr.20160414.

Tezal M, Wactawski-Wende J, Grossi SG, Ho AW, Dunford R, Genco RJ. The relationship between bone mineral density and periodontitis in postmenopausal women. J Periodontol. 2000 Sep;71(9):1492–8.

Payne JB, Reinhardt RA, Nummikoski PV, Patil KD. Longitudinal alveolar bone loss in postmenopausal osteoporotic/osteopenic women. Osteoporos Int. 1999;10(1):34-40.

Al-Dam A, Blake F, Atac A, Amling M, Blessmann M, Assaf A, et al. Mandibular cortical shape index in non-standardised panoramic radiographs for identifying patients with osteoporosis as defined by the German Osteology Organization. J Craniomaxillofac Surg. 2013 Oct;41(7):e165-9. doi: 10.1016/j.jcms.2012.11.044.

Dagistan S, Bilge OM. Comparison of antegonial index, mental index, panoramic mandibular index and mandibular cortical index values in the panoramic radiographs of normal males and male patients with osteoporosis. Dentomaxillofac Radiol. 2010 Jul;39(5):290-4. doi: 10.1259/dmfr/46589325.

Taguchi A, Ohtsuka M, Tsuda M, Nakamoto T, Kodama I, Inagaki K, et al. Risk of vertebral osteoporosis in post-menopausal women with alterations of the mandible. Dentomaxillofacial Radiol. 2007 Mar;36(3):143–8. doi: 10.1259/dmfr/50171930.

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