The Association Between Osteoporosis and Alveolar Crestal Height in Postmenopausal Women Jean Wactawski-Wende,* † Ernest Hausmann, ‡ Kathleen Hovey,* Maurizio Trevisan,* Sara Grossi, ‡ and Robert J. Genco § Background: Evidence supporting an association between osteoporosis and loss of alveolar crestal bone is limited. This study investigated that association in a large cohort of post- menopausal women. Methods: A cohort of 1,341 postmenopausal women aged 53 to 85 were assessed for alveolar crestal height (ACH) and bone density. ACH was determined from oral radiographs with subjects dichotomized by disease severity. Bone density was assessed by dual energy x-ray absorptiometry, with sever- ity determined by worst T score measured (normal >-1.00; low -1.00 to -2.00; moderate -2.01 to -2.49; osteoporotic <-2.5). Results: Compared to subjects in the normal T-score group, the odds of worse ACH increased by 39%, 59%, and 230% for those in the low, moderate, and osteoporotic groups, respec- tively. Adjustment for weight, education, hormone use, calcium or vitamin D supplementation, and smoking did not apprecia- bly change the findings. Further adjustment for age attenuated the association, with osteoporotic subjects having a 1.9-fold increase of being in the worst ACH group (95% confidence interval [CI] 1.19 to 3.05). After age stratification, in women younger than 70 there was a significant trend by decreasing T-score category (P <0.02). Osteoporotic subjects had worse ACH (odds ratio [OR] = 1.95; 95% CI 1.20 to 3.17). In women aged 70 and older, worse ACH was 2.5- to 4.6-fold increased for decreasing T-score category. After adjustment, the OR (95% CI) for the low, moderate, and osteoporotic groups were 2.66 (1.12 to 6.29), 2.31 (0.89 to 6.01), and 3.57 (1.42 to 8.97), respectively (P trend = 0.026). Conclusions: This study found a strong and consistent asso- ciation between T score and ACH in postmenopausal women. Increasing age is an important modifier of that association. J Periodontol 2005;76:2116-2124. KEY WORDS Bone mineral density; osteoporosis; periodontal diseases; postmenopause; women. O steoporosis is a skeletal disorder characterized by compromised bone strength predisposing to increased risk of fracture, with bone strength determined by both bone den- sity and bone quality. 1 Periodontitis has historically been described as an infec- tion-mediated process characterized by resorption of the alveolar bone as well as loss of the soft tissue attachment to the tooth and is a major cause of tooth loss and edentulousness in adults. 2 Periodon- tal disease is typically assessed by de- termination of loss of clinical attachment (CAL) of the soft tissue surrounding the teeth or by measures of oral bone loss, including loss of alveolar crestal height (ACH) surrounding the teeth. Findings of studies on the association of osteoporo- sis and periodontal disease have been somewhat inconsistent due, at least in part, to variation in study design and methods. Factors that likely influence interpretation of findings include small study samples, differing underlying prev- alence of osteoporosis and periodontitis in study groups, and use of varying measures and definitions of both peri- odontal disease and osteoporosis. 3,4 The relationship between osteoporosis and periodontal disease appears to be most consistent in studies of the relation of osteoporosis or skeletal bone mineral density to ACH. However, to date, no large studies of this relationship in post- menopausal women have been con- ducted where this relationship can be assessed while considering the impact of * Department of Social and Preventive Medicine, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY. † Department of Gynecology and Obstetrics, School of Medicine and Biomedical Sciences, University at Buffalo. ‡ Department of Oral Biology, School of Dental Medicine, University at Buffalo. § Department of Oral Biology, School of Dental Medicine, and Department of Microbiology, School of Medicine and Biomedical Sciences, Office of Science, Technology Transfer, and Economic Outreach (STOR), University at Buffalo. Volume 76 • Number 11 (Suppl.) 2116