Association between the severity of periodontitis and osteoarthritis in middle-aged and older patients with type 2 diabetes: a nationwide population-based study

Objective: Periodontitis and osteoarthritis are major public health concerns that result in decreased quality of life among middle-aged and older adults. We sought to examine whether the severity of periodontitis is related to osteoarthritis according to the presence of type 2 diabetes.

Methods: This study included 3,527 participants aged ≥50 years from the Korean National Health and Nutrition Examination Survey. Periodontitis was assessed using the Community Periodontal Index; severe periodontitis was defined as periodontal tissue forming deep periodontal pockets ≥6 mm depth. Osteoarthritis was defined as Kellgren-Lawrence grade ≥2 on radiographic images of the knee or hip area with joint pain. The odds ratios (ORs) and 95% confidence intervals (CIs) for osteoarthritis according to the severity of periodontitis, stratified by type 2 diabetes, were calculated using multiple logistic regression analyses.

Results: Participants with type 2 diabetes were more likely to have osteoarthritis as the severity of periodontitis increased (nonsevere periodontitis: 1.23 [0.67-2.32]; severe periodontitis: 3.01 [1.51-5.84]) after adjusting for age, sex, body mass index, smoking status, alcohol consumption, regular exercise, education level, household income, hypertension, and frequent tooth-brushing. However, this positive association was not found in individuals without type 2 diabetes after adjusting for the same co-variables.

Conclusions: Severe periodontitis was positively and significantly associated with osteoarthritis in middle-aged and older individuals with type 2 diabetes. Our findings suggest that the oral inflammation manifesting in periodontitis may be at least partly involved in the pathogenesis of osteoarthritis, particularly in patients with type 2 diabetes.

Keywords: osteoarthritis; periodontitis; type 2 diabetes.