Current vitamin D status and history of tooth loss in postmenopausal women
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Background: Vitamin D is hypothesized to influence development of periodontal disease (PD). Maintaining an adequate status of vitamin D is essential for bone health and vitamin D is hypothesized to also be important to the body's immune response. To the best of our knowledge, there have been no studies that have investigated the association between blood concentrations of 25-hydroxyvitamin D (25(OH)D), a biomarker of vitamin D status, and tooth loss due to periodontal disease and caries in a large epidemiologic study. Previous studies on vitamin D and tooth loss have not used the biomarker of 25(OH)D and have not differentiated reason for tooth loss in their analyses. Purpose: Using data from the Osteoporosis and Periodontal Disease Study (OsteoPerio), an ancillary study of the Women's Health Initiative Observational Study, we investigated the association between the plasma 25(OH)D concentrations and self-reported tooth loss due to any reasons (n=690), periodontal disease (n=75) and caries (n=615), assessed via self-report at the study baseline (1997-2000), among 857 postmenopausal women. Methods: The number of teeth present together with the number of teeth missing was assessed at the study baseline oral examination performed by trained dental health professional examiners. Information about the specific reason for every missing tooth was self-reported to the oral examiner during the oral examination. Plasma 25(OH)D concentrations were determined using the chemiluminescence DiaSorin LIAISON® assay. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for tooth loss due to any reasons and by specific reason (periodontal disease and caries) according to the vitamin D status based on 25(OH)D concentration in nmol/L: deficient 25(OH)D < 30, inadequate 25(OH)D ≥30 to < 50, adequate ≥50 to < 75, and adequate ≥75. Deficient status was used as the referent group. ORs were adjusted for age, annual family income, pack-years of smoking, frequency of dental visits, waist circumference and recreational physical activity. P for trend was estimated by using median 25(OH)D concentration in each vitamin D status category as an independent, ordinal variable in the model. We also examined effect modification by daily total calcium intake (md/day). A p for interaction of < 0.10 was considered statistically significant. Results: In this cross-sectional study, we observed no association between vitamin D status and tooth loss due to periodontal disease. The adjusted OR for women with adequate [25(OH)D ≥ 75 nmol/L] compared to deficient [25(OH)D < 30 nmol/L] was 1.11, 95% CI: 0.31, 3.93, p for trend= 0.272. Although we did not find statistically significant associations, we did observe an increased odds of having tooth loss due to any reasons and caries among women with adequate compared to deficient vitamin D status [(OR= 1.77. 95% CI: 0.79, 4.00), p for trend= 0.033 and (OR= 1.98, 95% CI: 0.86, 4.55), p for trend =0.026, respectively]. Further, our results did not show evidence of effect modification by total calcium intake. Conclusion: The lack of the association between vitamin D status and tooth loss due to periodontal disease could be explained by the lack of sufficient sample size, limited generalizability of the study population and temporality of the association. Prospective analyses of vitamin D status and tooth loss (including reason for tooth loss), will be necessary to better understand the role of vitamin D in tooth loss caused by periodontal disease and caries, which are the major primary causes of edentulism among the elderly.