# Nutritional Biomarkers, Bone Turnover, and Oxidative DNA Damage in Postmenopausal Women with Periodontitis: A Cross-Sectional Study

## TL;DR

This study finds that low bone density is linked to worse gum disease in postmenopausal women, and better nutrition, especially vitamin D and omega-3s, may help reduce gum damage.

## Contribution

The study identifies specific nutritional biomarkers that correlate with periodontal destruction and bone health in postmenopausal women.

## Key findings

- Low BMD is associated with greater periodontal destruction (mean CAL 2.06 vs. 1.45 mm).
- Higher 25(OH)D and omega-3 index are independently linked to lower mean CAL.
- Nutritional biomarkers correlate with pathways involved in periodontal destruction and remodeling.

## Abstract

Background/Objectives: Periodontitis and low BMD often occur after menopause, but the role of nutritional status in the oral–skeletal link is unclear. This study examined whether nutritional biomarkers relate to periodontitis severity and modify the relationship between low BMD and periodontal destruction in postmenopausal women. Methods: This cross-sectional study included 120 postmenopausal women who underwent comprehensive periodontal measurements at six sites per tooth and were classified according to the 2017 World Workshop staging and grading framework. Areal BMD was measured using dual-energy X-ray absorptiometry (DXA). Objective biomarkers included serum 25(OH)D, plasma vitamin C, RBC omega-3 index, and serum ferritin. Mechanistic measures were serum CTX, P1NP, and urinary 8-OHdG/creatinine. The main periodontal outcome was the mean CAL. Results: Low BMD was associated with greater periodontal destruction (mean CAL 2.06 vs. 1.45 mm; adjusted β = 0.664 mm, 95% CI 0.465–0.863; p < 0.001). Higher 25(OH)D and omega-3 index were independently associated with lower mean CAL (β = −0.024 mm per 1 ng/mL and β = −0.107 mm per 1%, respectively), with false discovery rate control applied across nutritional biomarkers. Across the cohort, serum 25(OH)D showed a weak inverse correlation with CTX (r = −0.14; p = 0.141), and exploratory mediation analyses suggested only small indirect effects via CTX and 8-OHdG. Conclusions: In women after menopause, lower BMD is associated with greater periodontal tissue loss. Objective nutritional biomarkers, especially 25(OH)D and omega-3 levels, correlate with biologically plausible pathways involved in periodontal destruction and remodeling. This supports the idea that nutrition could be a key factor linking oral health and skeletal health.