{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T01:07:11Z","timestamp":1769044031642,"version":"3.49.0"},"reference-count":40,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T00:00:00Z","timestamp":1724284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Osteoporosis is a common systemic bone disorder in the elderly, characterized by low bone mineral density and deterioration of bone structure. Apical periodontitis is an inflammatory response to the microbial infection of root canals, typically characterized by apical bone destruction surrounding the tooth\u2019s apex. This systematic review aimed to determine if osteoporosis affects the prevalence of apical periodontitis in adults. PRISMA guidelines have been followed. It included randomized clinical trials, cross-sectional, cohort, and case-control studies, and excluded non-relevant investigations and various secondary sources. A comprehensive search was performed in PubMed, Scopus, and Web of Science, until 13 March 2024. The Newcastle\u2013Ottawa Scale was used to assess the quality of the three selected studies: two cross-sectional studies and one case-control study. One investigation only included post-menopausal women recruited at a dental university clinic, the other integrated data from the total hospital patients\u2019 population, and the third selected patients referred to the university dental clinic from the university hospital. The findings varied: one study noted a marginal association between low bone mineral density and apical periodontitis, another found a significant association, and the third, with the lowest risk of bias, reported no link. The main limitations were the scarcity of eligible studies and their overall quality. The review was registered in the PROSPERO database (CRD42024523705), applied strict inclusion criteria and thorough searches by experienced and independent reviewers. There is no strong evidence that adult individuals with osteoporosis have a higher probability of developing apical periodontitis. However, clinicians should remain cautious of osteoporosis\u2019s potential impact on apical periodontitis development.<\/jats:p>","DOI":"10.3390\/dj12080272","type":"journal-article","created":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T04:26:57Z","timestamp":1724300817000},"page":"272","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Osteoporosis and Apical Periodontitis Prevalence: A Systematic Review"],"prefix":"10.3390","volume":"12","author":[{"given":"Nat\u00e1lia","family":"Pestana de Vasconcelos","sequence":"first","affiliation":[{"name":"Health Science Faculty, University Fernando Pessoa, 4200-150 Porto, Portugal"},{"name":"CINTESIS, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3242-388X","authenticated-orcid":false,"given":"Isabel Silva","family":"Martins","sequence":"additional","affiliation":[{"name":"Health Science Faculty, University Fernando Pessoa, 4200-150 Porto, Portugal"},{"name":"CINTESIS, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"}]},{"given":"Am\u00e9rico Santos","family":"Afonso","sequence":"additional","affiliation":[{"name":"Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1991-9418","authenticated-orcid":false,"given":"Ana Cristina","family":"Braga","sequence":"additional","affiliation":[{"name":"ALGORITMI Research Centre, LASI, University of Minho, 4710-057 Braga, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5885-0724","authenticated-orcid":false,"given":"Irene","family":"Pina-Vaz","sequence":"additional","affiliation":[{"name":"Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal"},{"name":"CINTESIS@RISE, MEDCIDS, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,22]]},"reference":[{"key":"ref_1","first-page":"RE01","article-title":"Narrative Review on Osteoporosis: A Silent Killer","volume":"18","author":"Shrihari","year":"2024","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2137","DOI":"10.1007\/s00198-022-06454-3","article-title":"Global, regional prevalence, and risk factors of osteoporosis according to the World Health Organization diagnostic criteria: A systematic review and meta-analysis","volume":"33","author":"Xiao","year":"2022","journal-title":"Osteoporos. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1111\/iej.13789","article-title":"Impact of systemic health on treatment outcomes in endodontics","volume":"56","author":"Cintra","year":"2023","journal-title":"Int. Endod. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1111\/ger.12076","article-title":"Radiolucent periapical lesions and bone mineral density in post-menopausal women","volume":"32","year":"2015","journal-title":"Gerodontology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1002\/cre2.604","article-title":"Periapical status in patients affected by osteoporosis: A retrospective clinical study","volume":"8","author":"Cadoni","year":"2022","journal-title":"Clin. Exp. Dent. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"68916","DOI":"10.18632\/oncotarget.20325","article-title":"Association between essential hypertension and bone mineral density: A systematic review and meta-analysis","volume":"8","author":"Ye","year":"2017","journal-title":"Oncotarget"},{"key":"ref_7","first-page":"2237","article-title":"Causal relationship between circulating inflammatory factors and osteoporosis: A bidirectional Mendelian randomization study","volume":"28","author":"Yi","year":"2024","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"46","DOI":"10.5152\/eurjrheum.2016.048","article-title":"An overview and management of osteoporosis","volume":"4","year":"2017","journal-title":"Eur. J. Rheumatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1080\/13697137.2018.1555582","article-title":"Assessment and hormonal management of osteoporosis","volume":"22","year":"2019","journal-title":"Climacteric"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1016\/j.joen.2008.07.028","article-title":"Clinical implications and microbiology of bacterial persistence after treatment procedures","volume":"34","author":"Siqueira","year":"2008","journal-title":"J. Endod."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1067\/moe.2002.126163","article-title":"Endodontic infections: Concepts, paradigms, and perspectives","volume":"94","author":"Siqueira","year":"2002","journal-title":"Oral. Surg. Oral. Med. Oral. Pathol. Oral. Radiol. Endod."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/j.1601-1546.2012.00279.x","article-title":"Biofilms in endodontic infection","volume":"22","author":"Siqueira","year":"2010","journal-title":"Endod. Top."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1016\/j.joen.2023.07.024","article-title":"The Link Between Apical Periodontitis and Gastrointestinal Diseases-A Systematic Review","volume":"49","author":"Jakovljevic","year":"2023","journal-title":"J. Endod."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1111\/iej.13467","article-title":"The global prevalence of apical periodontitis: A systematic review and meta-analysis","volume":"54","author":"Michelon","year":"2021","journal-title":"Int. Endod. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1111\/iej.12507","article-title":"Endodontic medicine: Connections between apical periodontitis and systemic diseases","volume":"48","year":"2015","journal-title":"Int. Endod. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1016\/j.joen.2020.07.007","article-title":"Prevalence of Apical Periodontitis and Conventional Nonsurgical Root Canal Treatment in General Adult Population: An Updated Systematic Review and Meta-analysis of Cross-sectional Studies Published between 2012 and 2020","volume":"46","author":"Jakovljevic","year":"2020","journal-title":"J. Endod."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"60","DOI":"10.3892\/ijmm.2023.5263","article-title":"Interaction between apical periodontitis and systemic disease (Review)","volume":"52","author":"Ye","year":"2023","journal-title":"Int. J. Mol. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1016\/j.joen.2007.07.011","article-title":"Effect of an estrogen-deficient state and alendronate therapy on bone loss resulting from experimental periapical lesions in rats","volume":"33","author":"Xiong","year":"2007","journal-title":"J. Endod."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2002","DOI":"10.1016\/j.joen.2015.08.029","article-title":"Diminished Progression of Periapical Lesions with Zoledronic Acid in Ovariectomized Rats","volume":"41","author":"Wayama","year":"2015","journal-title":"J. Endod."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1111\/iej.13206","article-title":"Alendronate inhibits osteocyte apoptosis and inflammation via IL-6, inhibiting bone resorption in periapical lesions of ovariectomized rats","volume":"53","author":"Silva","year":"2020","journal-title":"Int. Endod. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/j.joen.2022.02.002","article-title":"Effects of Anti-Receptor Activator of Nuclear Factor Kappa B Ligand Antibody and Zoledronic Acid on Periapical Lesion Development in Mice","volume":"48","author":"Ikeda","year":"2022","journal-title":"J. Endod."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1007\/s10006-022-01084-9","article-title":"Prevalence of dental alterations in patients under bisphosphonates therapy: A systematic review","volume":"27","author":"Pauli","year":"2023","journal-title":"Oral. Maxillofac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Dereci, \u00d6., Orhan, E.O., Irmak, \u00d6., and Ay, S. (2016). The effect of the duration of intravenous zolendronate medication on the success of non-surgical endodontic therapy: A retrospective study. BMC Oral. Health, 16.","DOI":"10.1186\/s12903-016-0163-6"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.joen.2020.10.019","article-title":"Prevalence of Periapical Lesions in Patients with Osteoporosis","volume":"47","author":"Katz","year":"2021","journal-title":"J. Endod."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/S0099-2399(86)80319-3","article-title":"A strategy for the diagnosis of periapical pathosis","volume":"12","author":"Halse","year":"1986","journal-title":"J. Endod."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2234","DOI":"10.1097\/PRS.0b013e3181f44abc","article-title":"Observational studies: Cohort and case-control studies","volume":"126","author":"Song","year":"2010","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1016\/j.joen.2009.09.028","article-title":"Identify and define all diagnostic terms for periapical\/periradicular health and disease states","volume":"35","author":"Gutmann","year":"2009","journal-title":"J. Endod."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1046\/j.1365-2591.2000.00295.x","article-title":"Periapical health related to the quality of root canal treatment in a Belgian population","volume":"33","author":"Hommez","year":"2000","journal-title":"Int. Endod. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1111\/j.1875-595X.2011.00087.x","article-title":"Frequency and distribution of root-filled teeth and apical periodontitis in an adult population of Barcelona, Spain","volume":"62","year":"2012","journal-title":"Int. Dent. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1016\/j.joen.2011.01.002","article-title":"Periapical and endodontic status of type 2 diabetic patients in Catalonia, Spain: A cross-sectional study","volume":"37","year":"2011","journal-title":"J. Endod."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1007\/s00198-023-06949-7","article-title":"Radiomorphometric indices of the mandible as indicators of decreased bone mineral density and osteoporosis\u2014Meta-analysis and systematic review","volume":"35","author":"Heuchert","year":"2024","journal-title":"Osteoporos. Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"413","DOI":"10.17219\/dmp\/143504","article-title":"Questionable accuracy of CBCT in determining bone density: A comparative CBCT-CT in vitro study","volume":"59","author":"Gaur","year":"2022","journal-title":"Dent. Med. Probl."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/j.1600-9657.1986.tb00119.x","article-title":"The periapical index: A scoring system for radiographic assessment of apical periodontitis","volume":"2","author":"Orstavik","year":"1986","journal-title":"Endod. Dent. Traumatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1093\/ibd\/izz128","article-title":"High Prevalence of Apical Periodontitis in Patients with Inflammatory Bowel Disease: An Age- and Gender- matched Case-control Study","volume":"26","year":"2020","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.joen.2014.12.024","article-title":"Glycated hemoglobin levels and prevalence of apical periodontitis in type 2 diabetic patients","volume":"41","year":"2015","journal-title":"J. Endod."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1016\/j.bone.2008.01.003","article-title":"Osteonecrosis of the jaw and bisphosphonate treatment for osteoporosis","volume":"42","author":"Rizzoli","year":"2008","journal-title":"Bone"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1016\/j.joen.2009.07.020","article-title":"A retrospective clinical and radiographic study on healing of periradicular lesions in patients taking oral bisphosphonates","volume":"35","author":"Hsiao","year":"2009","journal-title":"J. Endod."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/S0099-2399(97)80294-4","article-title":"Oral bone loss is increased in ovariectomized rats","volume":"23","author":"Gilles","year":"1997","journal-title":"J. Endod."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"75","DOI":"10.17219\/dmp\/139200","article-title":"Assessing the bone-healing potential of bone marrow mesenchymal stem cells in jawbone osteoporosis in albino rats","volume":"59","author":"Soliman","year":"2022","journal-title":"Dent. Med. Probl."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/12\/8\/272\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:40:52Z","timestamp":1760110852000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/12\/8\/272"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,22]]},"references-count":40,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["dj12080272"],"URL":"https:\/\/doi.org\/10.3390\/dj12080272","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,22]]}}}