{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T19:17:51Z","timestamp":1787944671569,"version":"build-2784847793"},"reference-count":30,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Res Protoc"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Periodontitis and low bone mineral density (BMD) are both highly prevalent among older women and share inflammatory and metabolic pathways, yet their co-occurrence and combined impact on tooth loss remain insufficiently characterized, particularly in Middle Eastern populations. Active matrix metalloproteinase-8 (aMMP-8), measured by point-of-care testing (PoCT) in oral rinse, is a candidate biomarker that may support periodontal screening in geriatric settings.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The primary objective is to determine and compare the prevalence and severity of periodontitis, classified using the 2017 American Academy of Periodontology and European Federation of Periodontology (AAP and EFP) classification system, between older women with low BMD (osteopenia or osteoporosis) and age-matched women with normal BMD. Secondary objectives are to compare clinical periodontal parameters and tooth loss between groups; to evaluate the diagnostic performance of aMMP-8 PoCT against the clinical periodontal diagnosis; and to examine associations among BMD, periodontal status, aMMP-8, and risk factors.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This single-center, cross-sectional study will recruit postmenopausal women aged 50 years or older who attend the geriatric clinics at Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar. Cases are women with a dual-energy X-ray absorptiometry (DXA) T-score of \u22121.0 or lower; controls are women with a T-score greater than \u22121.0. Each case will be individually matched to a control by age within 3 years. All participants will undergo a full-mouth periodontal examination by a single calibrated examiner, assessment of tooth loss, aMMP-8 oral rinse PoCT (20 ng\/mL cutoff), and comprehensive geriatric assessment and complete a structured questionnaire, with DXA results obtained from records. The target sample is 400 participants (200 per group). The primary matched comparison of periodontitis prevalence between groups will use the McNemar tests and conditional logistic regression; secondary analyses will use chi-square,\n t<\/jats:italic>\n , or Mann-Whitney\n U<\/jats:italic>\n tests; correlation; and regression in SPSS (version 27; 2-sided \u03b1 of .05).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n This protocol describes a study in its data collection phase. The study received ethics approval on September 1, 2025 (MRC-01-25-782), and it is funded by the Hamad Medical Corporation Medical Research Center (funding awarded in January 2026). Screening of eligible participants who met the inclusion criteria started in June 2026. Recruitment is anticipated to commence in October 2026 and is expected to be completed by October 2027. The primary results are anticipated for publication in early 2028. No outcome data are available at the time of submission.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The study will generate local evidence on the relationship between skeletal and oral health in older women and will evaluate whether aMMP-8 PoCT can serve as a practical, noninvasive screening adjunct in geriatric clinics. The findings are intended to inform integrated preventive and referral pathways in Qatar. Given the cross-sectional design, the study will characterize associations rather than establish causality.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/96991","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T18:43:33Z","timestamp":1787942613000},"page":"e96991-e96991","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence of Periodontitis and Tooth Loss Among Older Adult Women With Low Bone Mineral Density: Protocol for a Cross-Sectional Study"],"prefix":"10.2196","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0489-0501","authenticated-orcid":false,"given":"Shirmila","family":"Syamala","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6440-8780","authenticated-orcid":false,"given":"Sukumaran","family":"Anil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1060-6280","authenticated-orcid":false,"given":"Jafar","family":"Alabdallah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1771-8978","authenticated-orcid":false,"given":"Seham","family":"Alyafei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7412-5713","authenticated-orcid":false,"given":"Yasmine","family":"Eid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9581-4581","authenticated-orcid":false,"given":"Aishah","family":"Althuwaini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4732-805X","authenticated-orcid":false,"given":"Yasemin","family":"Sezgin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"issue":"5","key":"R1","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1111\/jre.13337","article-title":"Burden of severe periodontitis and edentulism in 2021, with projections up to 2050: the Global Burden of Disease 2021 study","volume":"59","author":"Nascimento","journal-title":"J Periodontal Res"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","DOI":"10.1186\/s12903-025-06108-w","article-title":"Global, regional, and national levels and trends in burden of dental caries and periodontal disease from 1990 to 2035: result from the Global Burden of Disease Study 2021","volume":"25","author":"Wu","journal-title":"BMC Oral Health"},{"issue":"2","key":"R3","first-page":"72","volume":"11","author":"Nazir","journal-title":"Int J Health Sci (Qassim)"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1177\/11795441211072471","article-title":"Prevalence of osteoporosis among Iranian postmenopausal women: a systematic review and meta-analysis","volume":"15","author":"Eghbali","journal-title":"Clin Med Insights Arthritis Musculoskelet Disord"},{"issue":"5","key":"R5","first-page":"401","volume":"36","author":"Straka","journal-title":"Neuro Endocrinol Lett"},{"issue":"4","key":"R6","doi-asserted-by":"publisher","first-page":"151","DOI":"10.4103\/jmh.JMH_55_17","article-title":"Osteoporosis and periodontitis in postmenopausal women: a systematic review","volume":"8","author":"Goyal","journal-title":"J Midlife Health"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1002\/JPER.20-0029","article-title":"Association between low bone mineral density and periodontitis in generally healthy perimenopausal women","volume":"92","author":"Gil-Montoya","journal-title":"J Periodontol"},{"issue":"3","key":"R8","doi-asserted-by":"publisher","first-page":"3508","DOI":"10.3892\/mmr.2015.3891","article-title":"Effects of estrogen deficiency on microstructural changes in rat alveolar bone proper and periodontal ligament","volume":"12","author":"Liu","journal-title":"Mol Med Rep"},{"issue":"11","key":"R9","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2023.e20922","article-title":"Association between periodontal disease and osteoporosis in postmenopausal women: a systematic review and meta-analysis","volume":"9","author":"Qi","journal-title":"Heliyon"},{"key":"R10","volume":"19","author":"Zamani","journal-title":"Dent Res J (Isfahan)"},{"issue":"8","key":"R11","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1080\/14789450.2021.1976151","article-title":"Active matrix metalloproteinase-8 (aMMP-8) point-of-care test (POCT) in the COVID-19 pandemic","volume":"18","author":"Sorsa","journal-title":"Expert Rev Proteomics"},{"issue":"11","key":"R12","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines11112885","article-title":"Active matrix metalloproteinase-8 (aMMP-8) versus total MMP-8 in periodontal and peri-implant disease point-of-care diagnostics","volume":"11","author":"R\u00e4is\u00e4nen","journal-title":"Biomedicines"},{"issue":"3","key":"R13","doi-asserted-by":"publisher","DOI":"10.3390\/biom10030395","article-title":"An oral rinse active matrix metalloproteinase-8 point-of-care immunotest may be less accurate in patients with Crohn\u2019s disease","volume":"10","author":"Rautava","journal-title":"Biomolecules"},{"issue":"8","key":"R14","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1111\/jcpe.14000","article-title":"Diagnostic accuracy of salivary active matrix metalloproteinase (aMMP)-8 point-of-care test for detecting periodontitis in adults: a systematic review and meta-analysis","volume":"51","author":"Wei","journal-title":"J Clin Periodontol"},{"issue":"12","key":"R15","doi-asserted-by":"publisher","first-page":"1600","DOI":"10.1093\/ntr\/nty147","article-title":"Impact of smoking cessation on periodontitis: a systematic review and meta-analysis of prospective longitudinal observational and interventional studies","volume":"21","author":"Leite","journal-title":"Nicotine Tob Res"},{"issue":"1","key":"R16","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/s00125-011-2342-y","article-title":"Periodontitis and diabetes: a two-way relationship","volume":"55","author":"Preshaw","journal-title":"Diabetologia"},{"issue":"2","key":"R17","doi-asserted-by":"publisher","first-page":"316","DOI":"10.3109\/13697137.2014.944495","article-title":"Bone mineral density in midlife women: the study of women\u2019s health in Qatar","volume":"18","author":"Gerber","journal-title":"Climacteric"},{"key":"R18","unstructured":"National health strategy. Ministry of Public Health, Qatar. URL: https:\/\/www.moph.gov.qa\/english\/NHS\/Pages\/default.aspx [Accessed 19-07-2026]"},{"issue":"Suppl 1","key":"R19","doi-asserted-by":"publisher","first-page":"S173","DOI":"10.1002\/JPER.17-0721","article-title":"Periodontitis: consensus report of workgroup 2 of the 2017 world workshop on the classification of periodontal and peri-implant diseases and conditions","volume":"89 Suppl 1","author":"Papapanou","journal-title":"J Periodontol"},{"issue":"Suppl 20","key":"R20","doi-asserted-by":"publisher","first-page":"S149","DOI":"10.1111\/jcpe.12945","article-title":"Staging and grading of periodontitis: framework and proposal of a new classification and case definition","volume":"45 Suppl 20","author":"Tonetti","journal-title":"J Clin Periodontol"},{"issue":"4","key":"R21","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"von Elm","journal-title":"J Clin Epidemiol"},{"issue":"3","key":"R22","doi-asserted-by":"publisher","first-page":"200","DOI":"10.7326\/0003-4819-158-3-201302050-00583","article-title":"SPIRIT 2013 statement: defining standard protocol items for clinical trials","volume":"158","author":"Chan","journal-title":"Ann Intern Med"},{"issue":"6","key":"R23","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1007\/BF01622200","article-title":"Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group","volume":"4","author":"Kanis","journal-title":"Osteoporos Int"},{"issue":"10","key":"R24","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.1007\/s00198-008-0712-1","article-title":"Case finding for the management of osteoporosis with FRAX--assessment and intervention thresholds for the UK","volume":"19","author":"Kanis","journal-title":"Osteoporos Int"},{"issue":"1","key":"R25","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1002\/jcsm.12048","article-title":"SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes","volume":"7","author":"Malmstrom","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD006211.pub2","article-title":"Comprehensive geriatric assessment for older adults admitted to hospital","author":"Ellis","journal-title":"Cochrane Database Syst Rev"},{"issue":"5","key":"R27","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1503\/cmaj.050051","article-title":"A global clinical measure of fitness and frailty in elderly people","volume":"173","author":"Rockwood","journal-title":"CMAJ"},{"issue":"2","key":"R28","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1111\/j.1447-0594.2012.00930.x","article-title":"Evaluation of a Japanese \u201cprevention of long-term care\u201d project for the improvement in oral function in the high-risk elderly","volume":"13","author":"Sakayori","journal-title":"Geriatr Gerontol Int"},{"key":"R29","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1099194","article-title":"Long-term trends in the burden of edentulism in China over three decades: a Joinpoint regression and age-period-cohort analysis based on the Global Burden of Disease Study 2019","volume":"11","author":"Qin","journal-title":"Front Public Health"},{"key":"R30","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2018.00057","article-title":"Unconditional or conditional logistic regression model for age-matched case-control data?","volume":"6","author":"Kuo","journal-title":"Front Public Health"}],"container-title":["JMIR Research Protocols"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T18:43:35Z","timestamp":1787942615000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.researchprotocols.org\/2026\/1\/e96991"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":30,"URL":"https:\/\/doi.org\/10.2196\/96991","relation":{},"ISSN":["1929-0748"],"issn-type":[{"value":"1929-0748","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"article-number":"v15i5e96991"}}