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There has been consistent intrigue on whether a systemic skeletal disease such as osteoporosis will amplify the alveolar bone loss in periodontitis. A survey of the literature published in the past 25\u00a0years indicates that systemic low bone mineral density (BMD) is associated with alveolar bone loss, while recent evidence also suggests a correlation between clinical attachment loss and other parameters of periodontitis. Inflammation and its influence on bone remodeling play critical roles in the pathogenesis of both osteoporosis and periodontitis and could serve as the central mechanistic link between these disorders. Enhanced cytokine production and elevated inflammatory response exacerbate osteoclastic bone resorption while inhibiting osteoblastic bone formation, resulting in a net bone loss. With aging, accumulation of oxidative stress and cellular senescence drive the progression of osteoporosis and exacerbation of periodontitis. Vitamin D deficiency and smoking are shared risk factors and may mediate the connection between osteoporosis and periodontitis, through increasing oxidative stress and impairing host response to inflammation. With the connection between systemic and localized bone loss in mind, routine dental exams and intraoral radiographs may serve as a low\u2010cost screening tool for low systemic BMD and increased fracture risk. Conversely, patients with fracture risk beyond the intervention threshold are at greater risk for developing severe periodontitis and undergo tooth loss. Various Food and Drug Administration\u2010approved therapies for osteoporosis have shown promising results for treating periodontitis. Understanding the molecular mechanisms underlying their connection sheds light on potential therapeutic strategies that may facilitate co\u2010management of systemic and localized bone loss.<\/jats:p>","DOI":"10.1111\/prd.12422","type":"journal-article","created":{"date-parts":[[2022,3,4]],"date-time":"2022-03-04T09:05:47Z","timestamp":1646384747000},"page":"99-113","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":384,"title":["Osteoporosis and periodontal diseases \u2013 An update on their association and mechanistic links"],"prefix":"10.1111","volume":"89","author":[{"given":"Bo","family":"Yu","sequence":"first","affiliation":[{"name":"Division of Regenerative and Constitutive Sciences School of Dentistry University of California at Los Angeles Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cun\u2010Yu","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Oral Biology and Medicine School of Dentistry University of California at Los Angeles Los Angeles California USA"},{"name":"Department of Bioengineering Henry Samueli School of Engineering and Applied Science Broad Stem Cell Research Center and Jonsson Comprehensive Cancer Center UCLA Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,4]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0757.2009.00326.x"},{"issue":"86","key":"e_1_2_11_3_1","first-page":"835","article-title":"American Academy of Periodontology Task Force Report on the Update to the 1999 Classification of Periodontal Diseases and Conditions","volume":"2015","year":"1999","journal-title":"J Periodontol"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1996.67.10s.1041"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.adaj.2018.04.023"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2005.11.024"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrd3299"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.061113"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1159\/000244610"},{"key":"e_1_2_11_10_1","first-page":"31","article-title":"Development of a classification system for periodontal diseases and conditions","volume":"79","author":"Armitage GC","year":"2000","journal-title":"Northwest Dent"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.18-0006"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.18-0157"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2249.2011.04335.x"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/prd.12021"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.16-0480"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12946"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)08761-5"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tripleo.2007.09.013"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2007.070155"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1259\/dmfr\/28366679"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1259\/dmfr\/50171930"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-005-1955-8"},{"key":"e_1_2_11_23_1","first-page":"1279","article-title":"The pattern of alveolar crest height change in healthy postmenopausal women after 3 years of hormone\/estrogen replacement","volume":"73","author":"Hildebolt CF","year":"2002","journal-title":"Therapy"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1067\/moe.2001.116494"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2000.71.9.1492"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.dmfr.4600445"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s001980050191"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1992.63.8.657"},{"key":"e_1_2_11_29_1","first-page":"23","article-title":"Bone mass of mandibles. 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