Using tetracyclines to treat osteoporotic/osteopenic bone loss: from the basic science laboratory to the clinic

Abstract

Periodontitis (progressive inflammatory disease characterized by alveolar bone loss, a major cause of tooth loss worldwide) is associated with both systemic osteoporosis and its milder form, osteopenia. Tetracyclines, by virtue of their non-antimicrobial pro-anabolic and anti-catabolic properties, are excellent candidate pharmaceuticals to simultaneously treat these local and systemic disorders. This paper reviews the foundational basic science and translational research which lead to a pivotal multicenter randomized clinical trial in postmenopausal women with both periodontitis and systemic (skeletal) osteopenia. This trial was designed primarily to examine whether subantimicrobial dose doxycycline (SDD) could reduce progressive alveolar (oral) bone loss associated with periodontitis and, secondarily, whether SDD could reduce systemic bone loss in the same subjects. This paper describes the efficacy and safety findings from this clinical trial and also outlines future directions using this promising and novel approach to manage both oral and systemic bone loss.

Copyright © 2010 Elsevier Ltd. All rights reserved.

Figures

Figure 1. Representative dental radiograph showing locations for alveolar bone density measurements

1 mm2 regions were measured at the alveolar crest (upper boxes; crestal area of interest) and immediately below the crestal area of interest (lower boxes; subcrestal area of interest) [30].

Figure 2. Representative dental radiograph showing alveolar bone height measurements

Alveolar bone height was measured from the cemento-enamel junction to the alveolar crest at posterior interproximal sites [30]. This figure shows the alveolar bone height measurement on the mesial surface of the mandibular left first molar and the distal surface of the mandibular left second premolar.

Figure 3. Diagrammatic representation of a relative clinical attachment level (RCAL) measurement on the mesial surface of a mandibular left second molar

RCAL represents a measurement of the distance from the occlusal surface of a tooth to the base of the periodontal pocket and is recorded to the nearest 0.2 mm [29]. In the multicenter randomized SDD clinical trial in postmenopausal women with periodontitis and systemic osteopenia, RCAL measurements were made on posterior teeth (premolars and molars).