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Purpose
The Buffalo Osteoporosis and Periodontal Disease (OsteoPerio) study is a prospective cohort study focused on the relationship between the microbiome and oral and systemic health outcomes in postmenopausal women. The cohort was established to examine how the oral microbiome is affected by (and how it affects) periodontal disease presence, se...
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Citations
... To examine P. gingivalis strains associated with periodontal disease we examined subgingival plaque samples from the Buffalo Osteoporosis and Periodontal Disease (OsteoPerio) Study 37 . The OstroPerio study is a prospective cohort study that was established to explore risk factors for the development and progression of osteoporosis and periodontal disease in postmenopausal women. ...
... The present study included 153 postmenopausal women enrolled in the Buffalo Osteoporosis and Periodontitis (OsteoPerio) Study, which is an ancillary study conducted at the Buffalo (NY) clinical center of the Women's Health Initiative Observational Study (WHI OS). Each participant in this study had a complete clinical oral examination 37 . The mean pocket depth (PD) and clinical attachment level (CAL) measurements define based on the criteria of Centers for Disease Control and Prevention (CDC)/American Academy of Periodontology (AAP) was used to determine the clinical periodontal disease status as none, mild, moderate, and severe 40 . ...
Porphyromonas gingivalis, a Gram-negative anaerobic bacterium commonly found in human subgingival plaque, is a major etiologic agent for periodontitis and has been associated with multiple systemic pathologies. Many P. gingivalis strains have been identified and different strains possess different virulence factors. Current oral microbiome approaches (16S or shotgun) have been unable to differentiate P. gingivalis strains. This study presents a new approach that aims to improve the accuracy of strain identification, using a detection method based on sequencing of the intergenic spacer region (ISR) which is variable between P. gingivalis strains. Our approach uses two-step PCR to amplify only the P. gingivalis ISR region. Samples are then sequenced with an Illumina sequencer and mapped to specific strains. Our approach was validated by examining subgingival plaque from 153 participants with and without periodontal disease. We identified the avirulent strain ATCC33277/381 as the most abundant strain across all sample types. The W83/W50 strain was significantly enriched in periodontitis, with 13% of participants harboring that strain. Overall, this approach can have significant implications not only for the diagnosis and treatment of periodontal disease but also for other diseases where P. gingivalis or its toxins have been implicated, such as Alzheimer's disease.
... Design of the WHIOS and OsteoPerio study has been published. 12,13 Neither periodontal disease status nor BP was an inclusion criterion for either study. The University at Buffalo human subjects Institutional Review Board approved both studies for which participants provided written informed consent. ...
... Table S1 gives baseline characteristics according to incident hypertension status among the 735 women who were without prevalent diagnosed hypertension at baseline. Women who (3), PPD (4), CAL (4), education (12), smoking (1), and general health (5). BMI indicates body mass index; BP, blood pressure; CAL, clinical attachment level; HEI, Healthy Eating Index; HT, menopausal hormone therapy; MET, metabolic equivalent task; nSES, neighborhood socioeconomic status; and PPD, probing pocket depth. ...
... Nat Med. (3), PPD (4), CAL (4), education (12), smoking (1), general health (5). Data are mean (SD) CLR bacteria relative abundance. ...
Background
Oral microbiota are thought to influence blood pressure (BP) regulation. However, epidemiological data supporting this hypothesis are limited. We examined associations between oral microbiota, BP, and incident hypertension in postmenopausal women.
Methods and Results
Baseline (1997–2001) examinations were completed on 1215 women (mean age, 63 years) during which subgingival plaque was collected, BP was measured, and medical and lifestyle histories and medication inventory were obtained. Microbiome composition of subgingival plaque was measured using 16S ribosomal RNA gene amplicon sequencing. Baseline measured BP was defined as normotensive (systolic <120 mm Hg and diastolic <80 mm Hg, no BP medication use; n=429); elevated (systolic ≥120 mm Hg or diastolic ≥80 mm Hg, no medication use; n=306); or prevalent treated hypertension (history of physician diagnosis treated with medications; n=480). Incident hypertension (375 cases among 735 without baseline treated hypertension) was defined as newly physician‐diagnosed hypertension treated with medication reported on annual health surveys (mean follow‐up, 10.4 years). Cross‐sectional analysis identified 47 bacterial species (of 245 total) that differed significantly according to baseline BP status ( P <0.05). Prospective analysis identified 15 baseline bacterial species significantly ( P <0.05) associated with incident hypertension: 10 positively (age‐adjusted hazard ratios [HRs], 1.10–1.16 per SD in bacterial abundance) and 5 inversely (HRs, 0.82–0.91) associated. Associations were materially unchanged after further adjustment for demographic, clinical, and lifestyle factors; were similar when analysis was restricted to the normotensive group; and were of consistent magnitudes between strata of baseline age, smoking, body mass index, and BP categories.
Conclusions
Specific oral bacteria are associated with baseline BP status and risk of hypertension development among postmenopausal women. Research to confirm these observations and elucidate mechanisms is needed.
... We studied the association between habitual dietary carbohydrate intake and the subgingival plaque oral microbiome in a cohort of 1204 postmenopausal women, using data from the Buffalo Osteoporosis and Periodontal Disease (OsteoPerio) Study, a cohort study ancillary to the Women's Health Initiative (WHI) Observational Study (OS) 25 . The OsteoPerio Study used 16S rRNA gene sequencing of oral plaque samples to identify and measure the relative abundance of the oral bacteria found 26 . We hypothesized that the alpha-diversity (within-subject diversity [number of species]) of the oral microbiome would be associated with intake of total carbohydrates, GL, starch, disaccharides (lactose, maltose, sucrose) and monosaccharides (fructose, galactose, and glucose) and that the beta-diversity (between group diversity) of the oral microbiome would differ across quartiles of intake in all carbohydrates and glycemic load (GL). ...
... Study design. The OsteoPerio Study is an ongoing prospective cohort 26 , and ancillary to the WHI, a national study focused on health outcomes of postmenopausal women 25 . The OsteoPerio study was originated to examine the association between osteoporosis and loss of bone in the oral cavity 27 . ...
... The OsteoPerio study was originated to examine the association between osteoporosis and loss of bone in the oral cavity 27 . Study participants were recruited from the WHI clinical center in Buffalo, NY between 1997 and 2001; 1,342 women participated in the baseline exam (Supplemental Fig. 1) 26 . Women were excluded if they had fewer than 6 teeth, bilateral hip replacement, a history of non-osteoporotic bone disease, a recent 10 years history of cancer, or if they were treated for serious diseases 26 . ...
Abstract Limited research exists on carbohydrate intake and oral microbiome diversity and composition assessed with next-generation sequencing. We aimed to better understand the association between habitual carbohydrate intake and the oral microbiome, as the oral microbiome has been associated with caries, periodontal disease, and systemic diseases. We investigated if total carbohydrates, starch, monosaccharides, disaccharides, fiber, or glycemic load (GL) were associated with the diversity and composition of oral bacteria in subgingival plaque samples of 1204 post-menopausal women. Carbohydrate intake and GL were assessed from a food frequency questionnaire, and adjusted for energy intake. The V3–V4 region of the 16S rRNA gene from subgingival plaque samples were sequenced to identify the relative abundance of microbiome compositional data expressed as operational taxonomic units (OTUs). The abundance of OTUs were centered log(2)-ratio transformed to account for the compositional data structure. Associations between carbohydrate/GL intake and microbiome alpha-diversity measures were examined using linear regression. PERMANOVA analyses were conducted to examine microbiome beta-diversity measures across quartiles of carbohydrate/GL intake. Associations between intake of carbohydrates and GL and the abundance of the 245 identified OTUs were examined by using linear regression. Total carbohydrates, GL, starch, lactose, and sucrose intake were inversely associated with alpha-diversity measures. Beta-diversity across quartiles of total carbohydrates, fiber, GL, sucrose, and galactose, were all statistically significant (p for PERMANOVA p
... Five years later, in 2018, Banack et al. [62] published the results of a 15-year prospective cohort study, called "OsteoPerio Study", to explore the risk factors for the development and progression of OP and PD in postmenopausal women and highlight the relationship between oral microbiota and oral and systemic health in postmenopausal women. The OsteoPerio Study results confirmed that: (1) OP women had almost double the risk of oral BMD loss compared to non-OP women; (2) systemic and oral BMD loss was greater in older women; (3) severity of PD was inversely associated with BMD. ...
Osteoporosis (OP) is a bone disease consisting of a progressive loss of bone mineral density (BMD) and therefore resulting in greater susceptibility to fractures. OP shares a number of risk factors and demographic characteristics with periodontitis (PD), a bacteria-induced chronic inflammation of periodontal structures that leads to loss of alveolar bone and teeth. In the last decade, with the advent of gut and oral microbiome studies and profiling, a growing diagnostic and prognostic significance has been attributed to dysbiosis associated with various systemic and organ-specific pathologies. This evidence has inspired research on modulating the microbiota to restore health by the use of prebiotics and probiotics. The aim of this work is to overview the bidirectional interrelationships between OP and PD, reporting the most recent evidence on triggering factors and, mainly, the role of gut and oral dysbiosis in the onset and progression of both OP and PD, with the perspective in their therapy.
... In reflecting on my relationship with Bob, I have thought a great deal about the value of mentorship in and of itself, but particularly in a team science environment. We met through our shared involvement in the Buffalo OsteoPerio study, Dr. Wactawski-Wende's large NIDCR-funded study of oral health in older women [1]. The OsteoPerio study is prospective cohort study focused on the relationship between the microbiome and oral and systemic health outcomes in postmenopausal women. ...
Purpose of Review
This paper highlights the value of mentorship based on lessons learned working with Dr. Robert (‘Bob’) Genco before he passed away in March 2019. Bob was a terrific mentor to researchers working in diverse environments, including academia, clinical settings, and industry.
Recent Findings
Five key dimensions of mentorship are discussed in this review: resources, opportunities, advice, protection, and interpersonal connection. Bob demonstrated that mentorship can and should be cross-disciplinary. Though we had very different areas of expertise, our joint involvement on a multidisciplinary research team provided ample opportunities for learning and knowledge translation.
Summary
Mentorship is particularly valuable for early and mid-career researchers seeking to develop a productive and well-funded program of research. My experience working with Bob taught me about the value of mentorship that encompasses both professional and interpersonal dimensions. Bob was a terrific mentor and will be missed by all who had the chance to work with him.
... OsteoPerio recruited participants from the Buffalo WHI-OS. This included 1342 participants at baseline (1997-2001; mean age 63 years), 1026 participants 5 years later (2002)(2003)(2004)(2005), and 518 women 17 years post baseline (2014-2018) [2] (see Fig. 1). ...
... The composition and diversity of the subgingival plaque microbiome were assessed by 16S ribosomal DNA (rDNA) sequencing with the Illumina high-throughput MiSeq platform in plaque samples from three time points [2]. Quality control was systematically evaluated throughout the sample preparation and sequencing procedures to ensure quality for use in longitudinal epidemiologic studies. ...
... NIDCR funding allowed us to implement the OsteoPerio Microbiome study, including a 17-year postbaseline visit [2]. Nearly 2600 subgingival plaque samples have now been characterized from plaque samples available at the three OsteoPerio time points using the 16S metagenomic sequencing technique. ...
Purpose of Review
Robert (“Bob”) Genco was a member of the research team that established the Buffalo Osteoporosis and Periodontal Disease (OsteoPerio) study. Here we detail the scientific discoveries emanating from this enduring collaboration.
Recent Findings
OsteoPerio is ancillary to the Women’s Health Initiative Observational Study (WHI-OS). WHI-OS is a longitudinal study of 93,676 postmenopausal women aged 50–79 enrolled at 40 US centers (enrolled in 1993–1998). OsteoPerio enrolled 1342 women 3 years later (1997–2001) from the Buffalo WHI-OS participants to study the association of osteoporosis and periodontal disease. OsteoPerio has 5-year (N = 1026) and 17-year (N = 518) follow-up examinations. In addition to information on health status from the WHI-OS, OsteoPerio further included comprehensive oral examinations assessing probing pocket depth, clinical attachment loss, gingival bleeding, alveolar crestal height, and decay/caries, missing, and filled teeth. Systemic bone density (measured by DXA), blood, saliva, and plaque also were collected at all three visits.
Summary
Findings from these studies are summarized here.
... Our work in this area started in 2009, in collaboration with Dr. Robert Genco, and continues to date. In the past decade, through analysis of [4], and the contribution of many investigators' work in this field, we have learned much about the potential role of vitamin D status in periodontal disease. This paper will review the most important literature on vitamin D and chronic periodontal disease in older adults. ...
Purpose of Review
The purpose of this review is to discuss the literature on associations between vitamin D and periodontal disease, including its strengths and weaknesses. Future direction for continued work in this area is provided.
Recent Findings
Research in cross-sectional cohorts, surveys, and case-control studies provide support for a role of vitamin D in periodontal disease, especially using clinical indicators such as bleeding on probing and clinical attachment loss. However, these studies have a number of limitations. They cannot establish temporality of these associations. Most case-control studies have been limited in sample size and have inconsistent findings. A number of cross-sectional studies are restricted to select populations (e.g., persons with HIV, diabetes, rheumatoid arthritis) limiting extrapolation of findings to the general aging population. Fewer prospective studies have been conducted, and only three have examined associations using a biomarker for vitamin D that reflects exposure from all its sources (sunlight, diet, and supplements). One study is limited by using self-reported measures of disease outcomes, and only two used measures of alveolar crestal height. However, of the prospective studies published, there is a suggestion that vitamin D might prevent against tooth loss. Only two randomized controlled trials have examined these associations, and they support the effects of vitamin D supplementation on prevention of tooth loss and gingival bleeding.
Summary
We strongly suggest that new research should focus on prospective study designs with follow-up of participants longer than a decade and long-term clinical trials. Such studies should incorporate measures of alveolar bone loss and tooth loss with indication for reason for tooth loss. Such clinical trials should be designed to examine both the influence of vitamin D supplementation alone as well as with other nutrients (e.g., calcium) or therapeutic medications (e.g., bisphosphonates). Currently, there is no strong evidence to suggest that vitamin D protects against development of periodontal disease.
... When applied to analysis of human oral microbiome data, it revealed differences of oligotypes (e.g., subspecies) in taxa separated by sequence variation of less than 1%. We have applied the 16S rRNA amplicon method to a study of the subgingival microbiota in postmenopausal women who exhibited periodontal health and a range of periodontal disease presence and severity based on clinical probing measures (Banack et al. 2018). In an earlier study on a small subset of these women, we observed considerable heterogeneity of oligotypes in the subgingival microflora between those with none/mild compared to severe periodontal disease . ...
... Participants were postmenopausal women initially enrolled in 1993 to 1998 in the Women's Health Initiative Observational Study (WHIOS; N = 2,249; ages 50 to 79 y) at the Buffalo, New York, Clinical Center, who then further enrolled in 1997 to 2001 into the ancillary Buffalo Osteoporosis and Periodontal Disease Study (OsteoPerio; N = 1,362; ages 53 to 81 y). Details of the WHIOS and OsteoPerio studies have been published (Langer et al. 2003;LaMonte et al. 2013;Banack et al. 2018). Periodontal disease status was not a criterion for study inclusion or exclusion. ...
... The procedures used to characterize the subgingival microbiome have been published (Banack et al. 2018). Briefly, genomic DNA was isolated using an automated system. ...
Understanding of the oral microbiome in relation to periodontal disease in older adults is limited. The composition and diversity of the subgingival microflora and their oligotypes in health and levels of periodontal disease were investigated in this study on older postmenopausal women. The 16S rRNA gene was sequenced using the Illumina MiSeq platform in 1,206 women aged 53 to 81 y. Presence and severity of periodontal disease were defined by Centers for Disease Control and Prevention/American Academy of Periodontology criteria. Composition of the microbiome was determined by 16S rRNA amplicon sequencing and the abundance of taxa described by the centered log 2 -ratio (CLR) transformed operational taxonomic unit (OTU) values. Differences according to periodontal disease status were determined by analysis of variance with Bonferroni correction. Bacteria oligotypes associated with periodontal disease and health were determined by minimum entropy decomposition and their functions estimated in silico using PICRUSt. Prevalence of none/mild, moderate, and severe periodontal disease was 25.1%, 58.3%, and 16.6%, respectively. Alpha diversity of the microbiome differed significantly across the 3 periodontal disease categories. β-Diversity differed between no/mild and severe periodontal disease, although considerable overlap was noted. Of the 267 bacterial species identified at ≥0.02% abundance, 56 (20.9%) differed significantly in abundance according to periodontal disease status. Significant linear correlations for pocket depth and clinical attachment level with bacterial amounts were observed for several taxa. Of the taxa differing in abundance according to periodontal disease status, 53% had multiple oligotypes appearing to differ between none/mild and severe periodontal disease. Among older women, taxonomic differences in subgingival microbiome composition and diversity were observed in relation to clinical periodontal disease measures. Potential differences in bacterial subspecies (oligotypes) and their function were also identified in periodontal disease compared with health.
Aim
To examine the association of dietary patterns with periodontal disease (PD) and its progression over 5 years.
Materials and Methods
Analyses involved 1197 post‐menopausal women from the OsteoPerio cohort. Dietary patterns assessed include Healthy Eating Index‐2015 (HEI), Alternative HEI (AHEI), Dietary Approaches to Stop Hypertension (DASH) and alternate Mediterranean Diet (aMed) at baseline (the average of two food frequency questionnaires administered between 1993 and 2001). At baseline and the 5‐year follow‐up, periodontal assessments evaluated alveolar crestal height (ACH), probing pocket depth (PPD), clinical attachment loss (CAL), percentage of gingival sites bleeding on probing (%BOP) and missing teeth due to PD. Linear and logistic regression were used to examine the associations.
Results
Cross‐sectionally, HEI and aMed were associated with smaller CAL and %BOP; along with DASH, they were associated with a decreased odds of teeth missing due to PD. AHEI and aMed were associated with a decreased odds of severe PD. Prospectively, AHEI was associated with greater ACH progression. This association was attenuated to the null after loss of ACH was imputed for teeth lost due to PD over follow‐up, or after excluding participants with diabetes, osteoporosis, hypertension or heart disease at baseline.
Conclusions
Better adherence to healthy dietary patterns was associated with better PD measures cross‐sectionally but greater progression of ACH over 5 years. The latter might be explained by incident tooth loss due to PD and pre‐existing comorbidities.
Objective
Hormone therapy can positively impact bone mineral density after menopause. We explored bone mineral density change in postmenopausal women who discontinued hormone therapy after the Women's Health Initiative landmark 2002 trial results were published. We secondarily explored whether usual physical activity modified the results.
Methods
Postmenopausal women participating in the Buffalo OsteoPerio study with information on hip bone density, hormone therapy use, and self-reported physical activity at two time points (1997-2001; 2002-2007) were included (N = 961). Hormone therapy included three groups according to use at baseline and year 5 (non/non; current/non; current/current).
Results
At baseline (mean age, 65.9 years; SD, 6.7 years), 480 women were not using hormone therapy, while 481 were current users. Between the baseline and 5-year visits, 336 women using hormone therapy discontinued. Baseline total hip bone density was highest in current users. After 5 years, those who continued hormone therapy exhibited no bone loss; those who discontinued exhibited the greatest loss at the total hip of −0.021 gm/cm ² . Women who never used hormone therapy exhibited some loss of −0.012 gm/cm ² . Usual physical activity did not appreciably impact change in bone density in any group.
Conclusions
This prospective observational study explored the 5-year change in bone mineral density among older postmenopausal women after the landmark 2002 hormone therapy trial findings were released. We found bone density decreased in never-users and in women who discontinued use. Bone density was maintained in current users. Although usual physical activity did not mitigate bone loss, targeted physical activity regimens should be investigated.
