Temporomandibular Disorders and Osteoporosis
Condition: Women; Osteoporosis; Osteopenia; Temporomandibular Disorder
MeSH terms: Osteoporosis; Temporomandibular Joint Disorders; Temporomandibular Joint Dysfunction Syndrome; Bone Diseases, Metabolic
Study type: Observational

Summary: 
      Increased life expectancy has attracted research attention, interested in provide a quality
      and healthy aging. According to the latest census conducted in 2010 by IBGE, Brazilian
      population consists of 97,342,162 women, whom estimates 30 million are between 40 and 65
      years old, a period that includes the climacteric. Therefore, clinical conditions such as
      osteoporosis becomes significant, either from public health policy standpoint or in relation
      to the social aspect, by compromising life quality. Women also suffer more from
      temporomandibular disorders (TMD) than men, and the beginning of this situation occurs after
      puberty, with peaks during the reproductive and remission periods after menopause. Female sex
      hormones involvement in osteoporosis is well established, but their participation in the TMD
      is still controversial. Thus, this study aims to investigate the role of systemic bone mass
      in menopausal women as a risk factor for articular TMD, as well as the TMD pain behavior
      during menopause transition periods (48 to 55 years), postmenopausal (56-65 years) and
      senescence (65-70 years). Therefore, 100 women attended by the HC - FMUSP Gynecology
      Division, Climacteric Sector, were clinically evaluated by the Research Diagnostic Criteria
      for Temporomandibular Disorders (RDC/TMD), used to obtain diagnoses and their associations,
      as well as to quantify the TMD pain sensitivity degree through the Craniomandibular Index
      (CMI), both applied by a single examiner. The bone densitometry provided bone mass data of
      femoral neck and lumbar spine (L1-L4). The RDC/TMD performance as a diagnostic test also was
      subjected to analysis, considering the 3.0 Tesla magnetic resonance imaging as reference
      standard, undergoing 30 women, of 100 assessed, in this imaging exam. After analyzing the
      results, it was shown that the risk posed by osteopenia was 1.33 (IC95% 1.20 - 1.46), with a
      risk increase of 0.33, while the risk of osteoporosis showed 1.39 (IC95% 1,20 - 1.23 to
      1.55), increased by 0.39. Joint diagnoses predominated (68.0%), while 18.0% muscular
      diagnoses and 14.0% corresponds to the absence of clinically diagnosable conditions,
      according to the RDC/TMD. The performance of the RDC/TMD to diagnose articular DTM revealed
      accuracy of 68.0%, sensitivity of 83.0%, specificity 53.0%, pre-test probability of 52.0%,
      positive predictive value of 60.0 % and negative 74.0%, positive likelihood ratio of 1.77 and
      negative 0.32. As for the soreness sensibility in TMD, it was found that aging shows a clear
      tendency towards its reduction (A =- 4.5, p = 0.0324). Then, the study concluded that the
      decrease in female sex hormones, peculiar to aging, increases the risk of articular TMD,
      although this pain disfunction decreases with age. The RDC/TMD can be used for large
      populations screening, but its indication in clinical practice should be done with caution.
    

Detailed description: 
      Osteoporosis and temporomandibular disorders are diseases which attack mainly women. Then,
      this research aims at if if they are related.
    

Observational model: Case-Crossover
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        patients attended by the discipline of gynecology - outpatient clinic of climatério
      
Keywords: osteoporosis; temporomandibular disorders; resonance magnetic