The association between sex hormones and periodontitis among American adults: A cross-sectional study

Front Endocrinol (Lausanne). 2023 Feb 14:14:1125819. doi: 10.3389/fendo.2023.1125819. eCollection 2023.

Abstract

Introduction: After adulthood, as a person grows older, the secretion of sex hormones in the body gradually decreases, and the risk of periodontitis increases. But the relationship between sex hormones and periodontitis is still controversial.

Methods: We investigated the association between sex hormones and periodontitis among Americans over 30 years old. 4,877 participants containing 3,222 males and 1,655 postmenopausal females who had had periodontal examination and detailed available sex hormone levels, were included in our analysis from the 2009-2014 National Health and Nutrition Examination Surveys cycles. We applied multivariate linear regression models to estimate the connection between sex hormones and periodontitis after converting sex hormones into categorical variables through tertile. Additionally, to ensure the stability of the analysis results, we carried out a trend test, subgroup analysis, and interaction test.

Results: After fully adjusting the covariates, estradiol levels were not associated with periodontitis in both males and females with a P for trend = 0.064 and 0.064, respectively. For males, we found that sex hormone-binding globulin was positively associated with periodontitis (tertile3 vs tertile1: OR=1.63, 95% CI=1.17-2.28, p = 0.004, P for trend = 0.005). Congruously, free testosterone (tertile3 vs tertile1: OR=0.60, 95% CI=0.43-0.84, p = 0.003), bioavailable testosterone (tertile3 vs tertile1: OR=0.51, 95% CI=0.36-0.71, p < 0.001), and free androgen index (tertile3 vs tertile1: OR=0.53, 95% CI=0.37-0.75, p < 0.001) was found to be negatively associated with periodontitis. Moreover, subgroup analysis of age found a closer relationship between sex hormones and periodontitis in those younger than 50 years.

Conclusion: Our research suggested that males with lower bioavailable testosterone levels affected by sex hormone-binding globulin were at a higher risk of periodontitis. Meanwhile, estradiol levels were not associated with periodontitis in postmenopausal women.

Keywords: NHANES; SHBG; bioavailable testosterone; periodontitis; sex hormones.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Estradiol
  • Female
  • Gonadal Steroid Hormones
  • Humans
  • Male
  • Middle Aged
  • Periodontitis* / epidemiology
  • Sex Hormone-Binding Globulin*
  • Testosterone

Substances

  • Sex Hormone-Binding Globulin
  • Gonadal Steroid Hormones
  • Testosterone
  • Estradiol

Grants and funding

This work was supported by the National Natural Science Foundation of China (Grant No.81902578, 81974098, 8197032158), Programs from the Science and Technology Department of Sichuan Province (2021YJ0462), The project of the Health Commission of Sichuan Province (2020PJ062, 20PJ039), Post-Doctoral Science Research Foundation of Sichuan University (2020SCU12041), and Post-Doctor Research Project, West China Hospital, Sichuan University (2018HXBH084, 2019HXBH092).