Changes in Inflammatory and Bone Turnover Markers After Periodontal Disease Treatment in Patients With Diabetes

Background: The underlying mechanisms for increased osteopenia and fracture rates in patients with diabetes are not well understood, but may relate to chronic systemic inflammation. We assessed the effect of treating periodontal disease (POD), a cause of chronic inflammation, on inflammatory and bone turnover markers in patients with diabetes. Materials and Methods: Using an investigator-administered questionnaire, we screened across-section of patients presenting for routine outpatient diabetes care. We recruited 22 subjects with POD. Inflammatory and bone turnover markers were measured at baseline and 3 months following POD treatment (scaling, root planing and subantimicrobial dose doxycycline). Results: There were nonsignificant reductions in high-sensitivity C-reactive protein (6.34-5.52 mg/L, P = 0.626) and tumor necrosis factor-alpha (10.37-10.01 pg/mL, P = 0.617). There were nonsignificant increases in urinary C-terminal telopeptide (85.50-90.23 pg/mL, P = 0.684) and bone-specific alkaline phosphatase (7.45-8.79 pg/mL, P = 0.074). Patients with >90% adherence with doxycycline were 6.4 times more likely to experience reduction in tumor necrosis factor-alpha (P = 0.021) and 2.8 times more likely to experience reductions in high-sensitivity C-reactive protein (P = 0.133). Conclusions: Treatment of POD in patients with diabetes resulted in nonsignificant lowering of inflammatory markers and nonsignificant increase in bone turnover markers. However, adherence to doxycycline therapy resulted in better treatment effects.