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

  • Wladimir Gushiken de Campos
  • Gonzalo André Montesinos
  • Rosa Cristina Peinado Agudo
  • Kaisermann Costa
  • Luciana Munhoz
  • Emiko Saito Arita


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.


1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. American Dental Association. Dental radiographic examinations: recommendations for patient
selection and limiting radioation exposure. FDA; revised 2012 [cited 2018 May 10]. Available
8. 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.
9. Klemetti E, Kolmakov S, Kröger H. Pantomography in assessment of the osteoporosis risk group. Eur
J Oral Sci. 1994 Feb;102(1):68-72.
10. 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.
11. 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.
12. Shapiro SS, Wilk MB. An analysis of variance test for normality (complete samples ). Biometrika.
1965 Dec;52(3):591-611. doi: 10.2307/2333709.
13. Loe H. Periodontal disease: the sixth complicat diabetes mellitus. Diabetes Care. 1993 Jan;16:329-34.
doi: 10.2337/diacare.16.1.329.
14. 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.
15. Kushi L, Folsom A, Prineas R, Mink P, Ying W, Bostick R. Postmenopausal women. N Engl J Med.
1996 May;334(18):1156-62.
16. 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.
17. 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
18. Payne JB, Reinhardt RA, Nummikoski PV, Patil KD. Longitudinal alveolar bone loss in postmenopausal
osteoporotic/osteopenic women. Osteoporos Int. 1999;10(1):34-40.
19. 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.
20. 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.
21. 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.
How to Cite
DE CAMPOS, Wladimir Gushiken et al. Does type 2 diabetic osteoporotic patients present more periodontal risks than non-osteoporotic patients? An evaluation with mandibular cortical index (Klemetti). Brazilian Journal of Oral Sciences, [S.l.], p. e181211, jan. 2019. ISSN 1677-3225. Available at: <>. Date accessed: 20 july 2019. doi:
Original Research

Most read articles by the same author(s)