One Drug Tackles Two Diseases, Case Researcher Finds: Prevent Bone Loss, Periodontal Disease

Leena Bahl Palomo, D.D.S and M.S.D., is the lead author on the study with Nabil Bissada, chair and professor of Case's department of periodontology; and James Liu, chair of the department of obstetrics and gynecology of University Hospitals of Cleveland.

During her graduate studies at Case, Palomo conducted one of the first studies to look at the impact of a group of bisphosphonates therapies for women with moderate and mild cases of osteoporosis and periodontal disease.

The study involved 60 postmenopausal women, who had been diagnosed with osteoporosis by doctors at University Hospitals of Cleveland and who had visited the Case dental clinics. She compared the women, who had been on daily or weekly bisphosphonate for at least three months to regenerate bone mass to those on no medications for the disease. The women were between the ages of 51 and 79, had T scores on bone scans of the hip or spine of 22.5. Half the group weighed approximately 127 pounds, and the overall study participants had similar alcohol and coffee daily intakes. The study participants did not smoke or use tobacco or estrogen products or have chronic medical conditions like diabetes that would increase the risks of periodontal disease. The risedronate group reported a higher use of vitamins and calcium supplements.

Each woman received an x-ray of the teeth and jaw and an oral examination that assessed the amount of inflammation, depth of the periodontal pocket, recession of the gums, mobility of the teeth and the presence of plaque--the standard parameters for gum disease as established by the American Academy of Periodontology. The examiner was unaware of who took medication.

In five of the six parameters, the risedronate therapy group had healthier periodontal status. Gum recession was not significantly different for either group.

The therapy group had significantly less plaque, which is an early indicator for periodontal disease. According to the researchers, risedronate therapy "is altering the periodontal status."

"We found a significant difference between the women who used the medications from the women who did not," said Palomo. "In the same way that the bisphosphonate is helping to prevent hip and vertebral fractures, the medications also prevent the loss of bone in the jaws--the bones which support the teeth."

"With a close link established between osteoporosis and periodontal disease, similar treatment and management of the disease might minimize tooth loss and the destruction of the alveolar (jaw) bone," reported Palomo.

Because bone loss is a "silent disease," and is many times diagnosed in older women after a hip or bone fracture, the researcher said dentists have the opportunity to observe signs of osteoporosis during a dental exam and can refer patients to the internist or gynecologist for a bone scan.

Palomo conducted the work under the direction of her thesis adviser, Bissada, and Liu from University Hospitals of Cleveland.

"This is more evidence to support the view of the mouth being a mirror of what's happening in the body," said Bissada. Case researchers have also found a link between periodontal disease and cardiovascular disease and complications in pregnancy.

"It also is nice to see that one medicine can help two diseases at the same time," added Bissada. "Drug companies are interested in better bone status for women," said Palomo, whose research was funded by Procter & Gamble, a maker of one of the leading brands of the bisphosphonate therapies for osteoporosis.

The researchers also suggest that this study could be used as a pilot for a longitudinal study to see what the long-term impact of risedronate therapy has on periodontal disease.

Palomo, who is a practicing periodontist in the Cleveland area, is a 2004 graduate of the periodontology program at Case, where she also earned her doctor of dental medicine degree in 2000 and her bachelor's degree in psychology and biology in 1996. Her research also won honors from the Midwest Society of Periodontology for her thesis paper, which was written as a requirement for her master's degree in periodontology. She presented the research findings to the 1,000 attendees at the society's annual meeting in Chicago.

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