Lowest osteocalcin in periodontitis associated with severe vitamin D3 deficiency

Vitamin D3 deficiency and local bone turnover

Vitamin D3 is linked to periodontal health indirectly, through bone metabolism and the immune response, but what happens locally, in the periodontal pocket itself, is rarely measured. The team led by Cevik measured exactly that, namely markers of bone remodelling in gingival crevicular fluid, and related them to the serum level of vitamin D3.

The study included 120 male non-smokers aged 25 to 40 years, 60 of them periodontally healthy and 60 with periodontitis. Each group was divided into three subgroups according to serum 25-hydroxyvitamin D3, into levels of 0 to 10, 11 to 20 and 21 to 30 ng/mL. Gingival crevicular fluid samples were taken from the buccal surfaces of maxillary premolars or molars, and osteocalcin and N-terminal telopeptide were determined by ELISA.

Total osteocalcin, a marker of bone formation, was significantly higher in the periodontally healthy than in affected patients (p < 0.001). Within the periodontitis group the lowest values were recorded in subjects with vitamin D3 between 0 and 10 ng/mL (p = 0.001). N-terminal telopeptide, a marker of resorption, did not differ significantly between the groups (p = 0.148), but in healthy subjects it fell as the vitamin D3 level rose (p = 0.049). The authors conclude that a pronounced vitamin D3 deficiency may be associated with an additional disturbance of local bone turnover in periodontal disease, noting that further research is needed.

Limitations

The sample is narrowly defined, as it covers only non-smokers and only men aged 25 to 40 years, so the finding does not transfer automatically to women, to older people or to smokers. The design is cross-sectional and does not prove causation; the study is registered under the number NCT06871631.

For your practice

• In a patient with periodontitis who responds poorly to therapy, the vitamin D3 level is a piece of information worth requesting from the family physician, but without any promise that supplementation will improve attachment.
• The finding concerns markers of bone remodelling, not a clinical outcome: there are no data that vitamin D3 supplementation changes probing depth.
• Do not prescribe supplementation yourself; the role of the doctor of dental medicine is to recognise the problem and refer the patient.