Periodontal Disease in Patients with Psoriatic Arthritis

Rheumatological diseases and periodontal disease are both characterized by dysregulation of the host inflammatory response. The aim of this study was to determine the possible relationship between periodontitis and psoriatic arthritis (PsA). Fifty-one adults with PsA (27 men and 24 women; mean age 41.73?±?11.27 years) and 50 age- and gender-balanced systemically healthy control subjects participated in the study. Participants' periodontal status as determined by probing pocket depth, clinical attachment loss (CAL), plaque index, and gingival index was evaluated. The CAL levels of the PsA group were significantly higher than those of the control group (p?<?0.05) There were no statistically significant differences in the frequency of periodontitis, probing pocket depth, plaque index, or gingival index between the two groups. The results of the present study show that periodontitis severity as determined by CAL was higher in the PsA group; therefore, periodontal evaluation must be considered when PsA is diagnosed.     

Changes in bone markers after once-weekly low-dose alendronate in postmenopausal women with moderate bone loss

BACKGROUND: High bone turnover, with bone resorption exceeding bone formation, is a major mechanism of postmenopausal osteoporosis. Therefore, inhibition of bone resorption is a rational approach for the prevention of bone loss. The objective of the current study was to determine the short-term efficacy of once-weekly low-dose alendronate in the prevention of bone loss, via bone turnover markers, in early postmenopausal Korean women with moderate bone loss. METHODS: This study involved a 12-week, randomized, double-blind clinical trial that compared the effects of placebo with alendronate 20mg once weekly. All subjects received supplemental calcium 600 mg and vitamin D 400IU daily. We recruited 63 postmenopausal women (ranging from 50 to 65 years of age) with the lowest lumbar spine bone mineral density (BMD) at least 2.0 S.D. below the mean value for young healthy adults. BMD was measured at baseline and serum alkaline phosphatase (ALP), osteocalcin, C-terminal telopeptide of type I collagen (CTX), and osteoprotegerin (OPG) were measured at baseline and 12 weeks after treatment. RESULTS: We randomly assigned 63 women to either placebo or alencronate 20 mg once a week for 3 months. Forty-nine women continued and completed all 3 months. After 3 months, bone resorption markers were significantly decreased in the alendronate group than in the placebo group: CTX -47.2% vs. 15% (p<0.01), ALP 1.6% vs. 25.9% (p=0.01), osteocalcin -29.2% vs. -13.6 (p=0.06). Women who received alendronate showed similar results to those who received placebo with regard to adverse events. CONCLUSION: Once-weekly low-dose alendronate may be a cost-effective and safe method of suppressing bone turnover in early postmenopausal women with moderate bone loss.     

Relationship between self-reported periodontal status and skeletal bone mineral density in Japanese postmenopausal women

OBJECTIVE: Several investigators have linked periodontal disease progression and low skeletal bone mineral density in postmenopausal women. However, little is known about whether self-reported periodontal status is the reflection of skeletal bone mineral density. We investigated whether self-reported poor periodontal status is associated with low skeletal bone mineral density in postmenopausal women. DESIGN: Relationships among self-reported periodontal status, number of teeth remaining, and bone mineral density of the lumbar spine and the femoral neck were evaluated in 253 Japanese postmenopausal women (mean +/- SD, 56.6 +/- 7.7) recruited from the patients who visited our clinic for bone mineral assessment between 1997 and 2003. Self-reported periodontal symptoms included gingival swelling, gingival bleeding, purulent discharge, and tooth mobility at the time of bone mineral assessment. RESULTS: Analysis of covariance adjusted for age, height, weight, years since menopause, duration of estrogen use, and regular oral care revealed that subjects without periodontal symptoms had significantly higher BMD of the lumbar spine than did those with periodontal symptoms (mean +/- SEM, 0.962 +/- 0.014 vs 0.921 +/- 0.013; P = 0.038); however, there were no significant differences in the number of remaining teeth and bone mineral density of the femoral neck between them. The odds of low spine bone mineral density in subjects with periodontal symptoms was 2.01 (95% CI = 1.15 to 3.50). CONCLUSION: Our results suggest that self-reported poor periodontal status may be associated with low bone mineral density of the lumbar spine in postmenopausal women.     

Surgical treatment of periodontal intrabony defects with calcium sulphate in combination with beta tricalcium phosphate--a 12-month retrospective clinical evaluation

Alloplastic bone graft materials are widely been used in combination with barrier membranes to achieve guided tissue regeneration in the treatment of periodontal intrabony defects. This study was designed to evaluate the clinical outcome of a composite material, beta tricalcium phosphate in combination with calcium sulphate in the treatment of periodontal intrabony defects. The combination of these materials is believed to aid in guided tissue regeneration owing to their properties. Thirty nine intrabony defects in 21 patients were treated with Fortoss Vital (Biocomposites, Staffordshire, UK). Clinical parameters were evaluated including changes in probing depth, clinical attachment level/loss and gingival recession at baseline and one year postoperatively. The mean differences in measurements between the baseline and one year postoperatively are a reduction of 1.98 +/- 1.16 mm (p = 0.000) in case of probing depth and a gain of 1.68 +/- 1.12 mm (p = 0.000) in clinical attachment level and an increase of 0.31 +/- 0.67 mm (p = 0.009) in gingival recession measurements. The study results show that the treatment with a combination of beta tricalcium phosphate and calcium sulphate led to a significantly favorable clinical improvement in periodontal intrabony defects one year postoperatively.     

C-reactive protein as a systemic marker of inflammation in periodontitis

Periodontitis has been identified as a potential risk factor for systemic pathologies such as cardiovascular disease (CVD). The aims of this investigation were to assess the relationship between periodontitis and systemic inflammatory factor, as well as to discover whether there is a relation to the severity of periodontitis and to the periodontopathogens. Periodontal examinations and serum C-reactive protein (CRP) level measurements were performed in 50 patients with periodontitis. Periodontal health indicators included the gingival bleeding on probing index and periodontal disease status. The patients with moderate periodontitis had low attachment loss and pocket depth <4 mm. The patients with severe periodontitis had high attachment loss and pocket depth >5 mm. The control group comprised 25 volunteers with healthy gingiva, gingival sulcus <2 mm and no attachment loss. The presence of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in subgingival plaque samples was analysed by the polymerase chain reaction (PCR) method. The periodontal parameters and CRP levels were significantly higher in the patients with periodontitis. Patients who had severe periodontitis, with high levels of mean clinical attachment loss, and subjects with moderate periodontitis had higher mean CRP levels. The percentage of subjects with elevated levels of CRP >5 mg/l was greater in the higher clinical attachment loss group compared to the group with lower attachment loss. The presence of P. gingivalis and A. actinomycetemcomitans were also associated with elevated CRP levels and poor periodontal status. Periodontitis and the presence of P. gingivalis are associated with an enhanced inflammatory response expressed by higher CRP levels. The association of periodontitis with CRP levels appears to be a contributing factor for CVD and might be a possible intermediate pathway in this association.     

The effect of tibolone on bone mineral density in postmenopausal women with osteopenia or osteoporosis--8 years follow-up

OBJECTIVES: This longitudinal observational study evaluated the effect of 8 years of uninterrupted treatment of tibolone on bone mineral density (BMD) in postmenopausal women with significant osteopenia or osteoporosis. MATERIAL AND METHODS: Subjects were 66 postmenopausal women (29 with moderate or severe osteopenia and 37 with osteoporosis) who took tibolone (2.5 mg nocte) uninterruptedly for over 8 years and who attended for annual BMD assessments. Their mean age was 66.7 (0.86) years (range 50-86 years). BMD measurements at the lumbar spine and proximal femur were performed annually by dual-energy X-ray absorptiometry (DEXA). RESULTS: During the 8 years of treatment with tibolone there was a significant increase in BMD at the spine (P < 0.001) and at the hip (P < 0.001). Women who did not have previous oestrogen therapy had significantly greater response to tibolone than those who had previous treatment with conventional hormone replacement therapy (HRT). CONCLUSION: This long-term observational study provides evidence of the effectiveness of tibolone in postmenopausal women with moderate/severe osteopenia and osteoporosis in terms of a significant increase in BMD.     

三联疗法治疗牙周病的临床效果观察

目的 探讨阿莫西林+奥美拉唑+奥硝唑治疗牙周病的临床效果。方法 选取2017年6月~12月于我院就诊的牙周病患者74例,随机分为对照组与研究组,各37例,所有患者常规处理后,对照组采用奥硝唑+阿莫西林治疗,研究组采用阿莫西林+奥美拉唑+奥硝唑治疗,观察两组牙龈疼痛、出血及牙齿松动等症状改善情况,评估总有效率。比较两组牙周探诊深度、临床附着丧失程度、菌斑指数等指标情况。结果 研究组牙周探诊深度、临床附着丧失程度、菌斑指数等指标均较之前下降,幅度优于对照组,差异有统计学意义（P＜0.05）;研究组临床治疗总有效率为89.19%,高于对照组的70.27%,差异有统计学意义（P＜0.05）。结论 三联疗法治疗牙周病疗效更为理想,有利于患者临床症状的缓解,减轻病痛。     

The influence of cellular source on periodontal regeneration using calcium phosphate coated polycaprolactone scaffold supported cell sheets

Cell-based therapy is considered a promising approach to achieving predictable periodontal regeneration. In this study, the regenerative potential of cell sheets derived from different parts of the periodontium (gingival connective tissue, alveolar bone and periodontal ligament) were investigated in an athymic rat periodontal defect model. Periodontal ligament (PDLC), alveolar bone (ABC) and gingival margin-derived cells (GMC) were obtained from human donors. The osteogenic potential of the primary cultures was demonstrated in vitro. Cell sheets supported by a calcium phosphate coated melt electrospun polycaprolactone (CaP-PCL) scaffold were transplanted to denuded root surfaces in surgically created periodontal defects, and allowed to heal for 1 and 4 weeks. The CaP-PCL scaffold alone was able to promote alveolar bone formation within the defect after 4 weeks. The addition of ABC and PDLC sheets resulted in significant periodontal attachment formation. The GMC sheets did not promote periodontal regeneration on the root surface and inhibited bone formation within the CaP-PCL scaffold. In conclusion, the combination of either PDLC or ABC sheets with a CaP-PCL scaffold could promote periodontal regeneration, but ABC sheets were not as effective as PDLC sheets in promoting new attachment formation.     

Application of chitosan gel in the treatment of chronic periodontitis

Local administration of antibiotics in periodontal therapy can be provided with an appropriate delivery system. The purpose of this study was to evaluate the clinical effectiveness of chitosan, both as a carrier in gel form and as an active agent in the treatment of chronic periodontitis (CP). The chitosan gel (1% w/w) incorporated with or without 15% metronidazole was prepared and applied adjunctive to scaling and root planing (SRP) in comparison to SRP alone (control group-C), in CP patients. The clinical parameters such as probing depth (PD), clinical attachment level, the amount of gingival recession, plaque index, gingival index, and gingival bleeding time index were recorded at baseline and at weeks 6, 12, and 24. In all groups, significant improvements were observed in clinical parameters between baseline and week 24 (p < 0.05). The reductions in PD values were 1.21 mm for Ch, 1.48 mm for Ch + M, and 0.94 mm for C groups. No complications related to the chitosan were observed in patients throughout the study period. It is suggested that chitosan itself is effective as well as its combination with metronidazole in CP treatment due to its antimicrobial properties.     

Antiphosphorylcholine Antibody Levels Are Elevated in Humans with Periodontal Diseases

Human immunoglobulin G2 (IgG2) serum concentrations and the IgG2 antibody response to Actinobacillus actinomycetemcomitans can be influenced by genes, by environmental factors such as smoking, and by periodontal disease status. Examination of the IgG2 response to phosphorylcholine (PC), a response thought to be mainly induced by the C polysaccharide of Streptococcus pneumoniae, suggested that periodontal disease status was also associated with this response. This prompted the hypothesis that PC is an important oral antigen associated with organisms in the periodontal flora and that anti-PC antibody is elevated as a consequence of periodontal disease. Subjects in various periodontal disease diagnostic categories in which attachment loss is exhibited were tested for anti-PC in serum. Those with adult periodontitis, localized juvenile periodontitis, generalized early-onset periodontitis, and gingival recession all had similar levels of anti-PC IgG2 serum antibody which were significantly greater than in the group of subjects with no attachment loss. Analysis of plaque samples from subgingival and supragingival sites in all diseases categories for reactivity with the anti-PC specific monoclonal antibody TEPC-15 revealed that a substantial proportion of the bacteria in dental plaque (30 to 40%) bear PC antigen; this antigen was not restricted to morphotypes resembling only cocci but was also present on rods and branched filamentous organisms. We found that S. mitis, S. oralis, and S. sanguis, as well as oral actinomycetes, including A. viscosus, A. odontolyticus, and A. israelii, incorporated substantial amounts of [(3)H]choline from culture media. Further analysis of antigens derived from these organisms by Western blot indicated that S. oralis, S. sanguis, A. viscosus, A. odontolyticus, and A. israelii contained TEPC-15-reactive antigens. The data show that many commonly occurring bacterial species found in dental plaque contain PC antigen and that immunization with plaque-derived PC antigens as a consequence of inflammation and periodontal attachment loss may influence systemic anti-PC antibody concentrations.     

Does osteopenia warrant treatment?

The progressive loss of bone mass that leads to osteoporosis in postmenopausal women is known to result in substantial morbidity and mortality. Underdiagnosed and undertreated, osteoporosis jeopardizes the health of an estimated 8 million American women 50 years of age or older who are at high risk for hip, vertebral, and other fractures. Because osteopenia is generally a subclinical condition that results in a lower fracture rate than osteoporosis, its potential impact is more difficult to recognize, although it is nearly three times more prevalent than osteoporosis. The question arises as to whether osteopenia should be diagnosed and treated before it transitions into osteoporosis. Because the number of postmenopausal women is projected to increase substantially in the near future and the number of postmenopausal women who will or who have discontinued their use of hormone therapy has increased sharply, the consequences of failing to identify and treat women at increased fracture risk are considerable. Moreover, the rate of bone loss in the first year after discontinuation of hormone therapy is especially rapid and similar to the rate that occurs early after menopause. Accordingly, fracture risk is substantially increased at this time in relation to the magnitude of bone loss. The goal of nonpharmacologic and pharmacologic therapy is to prevent the first fracture in any woman at risk for fracture. Initiation of antiresorptive therapy known to provide rapid efficacy can be particularly important in achieving the treatment goal in appropriate osteopenic women.     

Surgical treatment of periodontal intrabony defects with calcium sulphate in combination with beta-tricalcium phosphate: clinical observations two years post-surgery

The study was designed to evaluate the clinical outcome of a composite material, beta-tricalcium phosphate in combination with calcium sulphate, in the treatment of periodontal intrabony defects. The combination of these materials is believed to aid in guided tissue regeneration owing to their properties. A total of 47 teeth with intrabony defects in 26 periodontitis patients were treated with Fortoss Vital (Biocomposites, Staffordshire, U.K.). Clinical parameters were evaluated which included changes in probing depth, clinical attachment level/loss and gingival recession at the baseline and 2 years postoperatively. The mean differences in measurements between the baseline and 2 years postoperatively were a reduction of 2.07 +/- 1.14 mm (p = 0.000) in case of probing depth and a gain of 1.93 +/- 1.36 mm (p = 0.000) in clinical attachment level; but an increase of 0.14 +/- 0.73 mm (p = 0.571) in gingival recession. The study results show that the treatment with a combination of beta tricalcium phosphate and calcium sulphate led to a significantly favorable clinical improvement in periodontal intrabony defects 2 years after the surgery.     

Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group

BACKGROUND: Risedronate increases bone mineral density in elderly women, but whether it prevents hip fracture is not known. METHODS: We studied 5445 women 70 to 79 years old who had osteoporosis (indicated by a T score for bone mineral density at the femoral neck that was more than 4 SD below the mean peak value in young adults [-4] or lower than -3 plus a nonskeletal risk factor for hip fracture, such as poor gait or a propensity to fall) and 3886 women at least 80 years old who had at least one nonskeletal risk factor for hip fracture or low bone mineral density at the femoral neck (T score, lower than -4 or lower than -3 plus a hip-axis length of 11.1 cm or greater). The women were randomly assigned to receive treatment with oral risedronate (2.5 or 5.0 mg daily) or placebo for three years. The primary end point was the occurrence of hip fracture. RESULTS: Overall, the incidence of hip fracture among all the women assigned to risedronate was 2.8 percent, as compared with 3.9 percent among those assigned to placebo (relative risk, 0.7; 95 percent confidence interval, 0.6 to 0.9; P=0.02). In the group of women with osteoporosis (those 70 to 79 years old), the incidence of hip fracture among those assigned to risedronate was 1.9 percent, as compared with 3.2 percent among those assigned to placebo (relative risk, 0.6; 95 percent confidence interval, 0.4 to 0.9; P=0.009). In the group of women selected primarily on the basis of nonskeletal risk factors (those at least 80 years of age), the incidence of hip fracture was 4.2 percent among those assigned to risedronate and 5.1 percent among those assigned to placebo (P=0.35). CONCLUSIONS: Risedronate significantly reduces the risk of hip fracture among elderly women with confirmed osteoporosis but not among elderly women selected primarily on the basis of risk factors other than low bone mineral density.     

Polymorphisms of Fc gamma-receptors RIIa, RIIIa, and RIIIb in patients with adult periodontal diseases

Polymorphisms influencing the binding affinity between the Fcgamma receptors and IgG of different subclasses are thought to be of importance in the individual susceptibility to infections with Gram-negative bacteria contributing to periodontal disease. One hundred and fifty-four Caucasian subjects were clinically and radiographically examined for their periodontal status and genotyped for their allelic pattern of FcgammaRIIa, FcgammaRIIIa, and FcgammaIIIb polymorphism. In assessing periodontitis according to mean probing depth and attachment loss, no differences were found in allele frequencies or combined allotypes between the subjects with mild or moderate and those with severe signs of periodontitis. However, the extent and severity of bone loss were significantly associated with the genotype of the receptor FcgammaRIIIa. An increased risk of severe bone destruction was observed in individuals carrying the FcgammaRIIIa-VV genotype (OR = 5.3; 95% CI 1.4-26.2). FcgammaRIIIb is in linkage disequilibrium with FcgammaRIIIa. Hence it is also related to periodontal disease. There is no indication of an association between the polymorphism of FcgammaRIIa and periodontitis. The results are evidence that the FcgammaRIIIa genotype coding for the high affinity receptor imposes an additional risk of bone loss as does the FcgammaRIIIb genotype coding for the low affinity receptor.     

锥形束CT评价仙灵骨葆胶囊治疗绝经后女性牙周炎患者牙槽骨骨量的变化

文题释义：牙周炎：是一种由牙菌斑微生物感染引起的牙周支持组织感染性疾病,可导致牙槽组吸收,骨量丢失,是成年人牙齿丢失和缺损的主要病因。绝经后女性是牙周炎易感人群,绝经后机体雌孕激素的变化可恶化牙周炎病情,加速骨量丢失和骨组织微结构的变化。 仙灵骨葆胶囊：是临床治疗骨折、骨质疏松等常用中药制剂,滋补肝肾、活血通络、强筋壮骨。仙灵骨葆胶囊具有雌激素样作用,并能显著促进成骨细胞生成,对于绝经后女性骨质疏松有确切疗效。然而仙灵骨葆胶囊在绝经后女性牙周炎的报道较为少见,其对牙槽骨骨量影响值得探讨。 背景：仙灵骨葆胶囊具有减少骨质流失、促进成骨细胞生成作用,在骨质疏松骨折中疗效已经得到初步证实,但在绝经后女性牙周炎的疗效尚未阐明。 目的：应用锥形束CT技术评价仙灵骨葆胶囊对绝经后妇女牙周炎患者牙槽骨骨量的影响,为临床治疗提供有效依据。 方法：选择2015年10月至2017年4月贵阳中医学院第一附属医院口腔科诊治的135例牙周炎患者,随机分为空白组、对照组、试验组(基础治疗+仙灵骨葆胶囊),各45例。所有患者接受口腔卫生健康教育、指导患者正确刷牙方法、自我控制菌斑,实施龈上洁治、龈下刮治、根面平整等以消除菌斑及牙石的牙周病基础治疗,每3个月进行一次,连续治疗6个月。对照组同时口服钙尔奇-D(每片含钙600 mg、维生素D 125 U),1片/次,1次/d,连续治疗6个月;试验组口服仙灵骨葆胶囊1.0 g/次,3次/d,3个月为一疗程,连续治疗2个疗程。采用锥形束CT检测患者治疗前、治疗3个月、治疗6个月牙槽骨缺损高度及骨密度的变化。试验已于2015-05-29获得贵阳中医学院第一附属医院伦理会批准(编号：K2015-186)。 结果与结论：①与治疗前相比,试验组和对照组患者治疗后牙槽骨缺损高度显著缩小(P < 0.05),骨密度显著增高(P < 0.05),空白组牙槽骨缺损高度及骨密度均无变化(P > 0.05),试验组牙槽骨缺损高度和骨密度改善程度高于对照组(P < 0.05);②随着年龄增长,牙周炎病情加重,牙槽骨缺损高度逐渐增加,骨密度逐渐降低(P < 0.05),与治疗前相比,46-50岁组患者治疗后牙槽骨缺损高度和骨密度均显著改善(P < 0.05),51-55岁组患者骨密度增加明显(P < 0.05),牙槽骨缺损高度无显著改变(P > 0.05),>55岁组牙槽骨缺损高度、骨密度均无变化(P > 0.05);③轻度和中度牙周炎患者牙槽骨缺损高度和骨密度均显著改善(P < 0.05),重度牙周炎患者牙槽骨缺损高度和骨密度变化的差异无显著性意义(P > 0.05);④结果提示仙灵骨葆胶囊治疗绝经后妇女牙周炎可显著改善牙槽骨缺损高度、骨密度,同时锥形束CT可用于评估其临床疗效。 ORCID: 0000-0002-1977-639X(张钰晶) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

骨质疏松性牙周炎大鼠左归丸与雌激素治疗后颌骨结构和骨量的变化

背景：有研究表明经典补肾方剂左归丸可用于治疗绝经后女性的骨质疏松。 目的：观察骨质疏松性牙周炎大鼠左归丸与雌激素治疗后颌骨结构和骨量的变化。 方法：将SD大鼠麻醉下结扎上颌第一磨牙建立牙周炎模型、摘除大鼠卵巢建立骨质疏松模型,去势3个月后分别用左归丸和戊酸雌二醇治疗3个月。 结果与结论：左归丸、戊酸雌二醇治疗均能促进大鼠牙槽骨的新生,减轻牙周附着丧失(P < 0.05),使破骨细胞数量减少 (P  < 0.05),牙周组织中骨保护素水平升高(P < 0.01),降低了血清中的碱性磷酸酶水平(P  < 0.01)。结果证实,左归丸、戊酸雌二醇在改善骨质疏松性牙周炎大鼠牙槽骨结构的基础上,促使颌骨骨量增加。     

Combined treatment with vitamin k2 and bisphosphonate in postmenopausal women with osteoporosis

Vitamin K2, as well as bisphosphonates, such as etidronate, alendronate, and risedronate, is widely used in the treatment with osteoporosis in Japan. Etidronate increases the lumbar bone mineral density (BMD), and prevents new vertebral fractures, in patients with osteoporosis, while alendronate and risedronate increase the lumbar and femoral neck BMDs, and prevent new vertebral and femoral neck fractures. Vitamin K2 enhances gamma-carboxylation of bone glutamic acid residues and the secretion of osteocalcin, sustains the lumbar BMD, and prevents osteoporotic fractures in patients with osteoporosis. Bisphosphonates, such as alendronate and risedronate, rather than vitamin K2, should be initially chosen for the treatment of osteoporosis, because they are more efficacious than vitamin K2. Available evidence suggest that risedronate prevents deterioration of the connectivity of the trabeculae in ovariectomized rats, whereas vitamin K2 increase the trabecular thickness, and that a combination of risedronate and vitamin K2 has a synergistic effect on preventing the deterioration of trabecular bone architecture induced by estrogen deficiency. Some studies have shown that combined treatment with etidronate and vitamin K2 appears to be more effective than etidronate alone in the prevention of new osteoporotic vertebral fractures. Based on these findings, combined treatment with vitamin K2 and bisphosphonates may be more efficacious in the prevention new vertebral fractures than a single treatment with bisphosphonate in postmenopausal women with osteoporosis. Thus, this combined treatment should be recommended for the treatment of postmenopausal osteoporosis. It is proposed that the role of vitamin K2 should be emphasized, when used in combination with bisphosphonates, especially in patients with vitamin K deficiency.     

Hormonal replacement therapy and the skeletal system

The two most important risk factors for maintaining skeletal health are the bone mass obtained at skeletal maturity (peak bone mass) and the subsequent bone loss. Those women with a low peak bone mass and a rapid bone loss are thus at increased risk of developing osteoporosis in the future, and should be identified. This may be accomplished by determination of the bone mass combined with an estimate of the rate of the postmenopausal bone loss. The bone mass can be accurately assessed in the forearm by single photon absorptiometry. The postmenopausal bone loss can be estimated by three or four biochemical markers of bone turnover. The women at highest risk of developing osteoporosis should be offered preventive therapy, e.g., hormonal replacement therapy (HRT). HRT arrests the bone loss not only in early, but also in elderly postmenopausal women. The effect lasts as long as the therapy is continued. Several epidemiological studies have demonstrated that HRT decreases the number of osteoporotic fractures.     

A comparative clinical study of solid and granular porous hydroxylapatite implants in human periodontal osseous defects

Solid and granular porous hydroxylapatite implants were compared in the surgical treatment of angular interproximal periodontal defects in 10 subjects. After completion of initial therapy, presurgical measurements of pocket depth, attachment level, gingival recession, gingival fluid and tooth mobility were recorded. Six months after the surgery the measurements were repeated. The use of both forms of porous hydroxylapatite resulted in reduction in pocket depth, and probeable attachment level gains as well as gingival recession and reduction of gingival fluid and tooth mobility. These changes were similar for both granular and solid forms of porous hydroxylapatite.     

绝经期妇女骨质疏松症与心血管疾病

世界不同地区妇女平均绝经年龄为５０岁。世界银行１９９０年人口调查报告指出，５０岁以上妇女约有４７亿，预计２０３０年将增至１２亿。中国５０岁以上的妇女将占世界总数的２３％，为世界首位。年龄别心血管疾病死亡率妇女低于男子，但随年龄增加至７５岁时妇女与男...