Prevalence of Periodontitis and Tooth Loss Among Older Adult Women With Low Bone Mineral Density: Protocol for a Cross-Sectional Study

Abstract Background Periodontitis and low bone mineral density (BMD) are both highly prevalent among older women and share inflammatory and metabolic pathways, yet their co-occurrence and combined impact on tooth loss remain insufficiently characterized, particularly in Middle Eastern populations. Active matrix metalloproteinase-8 (aMMP-8), measured by point-of-care testing (PoCT) in oral rinse, is a candidate biomarker that may support periodontal screening in geriatric settings. Objective The primary objective is to determine and compare the prevalence and severity of periodontitis, classified using the 2017 American Academy of Periodontology and European Federation of Periodontology (AAP and EFP) classification system, between older women with low BMD (osteopenia or osteoporosis) and age-matched women with normal BMD. Secondary objectives are to compare clinical periodontal parameters and tooth loss between groups; to evaluate the diagnostic performance of aMMP-8 PoCT against the clinical periodontal diagnosis; and to examine associations among BMD, periodontal status, aMMP-8, and risk factors. Methods This single-center, cross-sectional study will recruit postmenopausal women aged 50 years or older who attend the geriatric clinics at Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar. Cases are women with a dual-energy X-ray absorptiometry (DXA) T-score of −1.0 or lower; controls are women with a T-score greater than −1.0. Each case will be individually matched to a control by age within 3 years. All participants will undergo a full-mouth periodontal examination by a single calibrated examiner, assessment of tooth loss, aMMP-8 oral rinse PoCT (20 ng/mL cutoff), and comprehensive geriatric assessment and complete a structured questionnaire, with DXA results obtained from records. The target sample is 400 participants (200 per group). The primary matched comparison of periodontitis prevalence between groups will use the McNemar tests and conditional logistic regression; secondary analyses will use chi-square, t , or Mann-Whitney U tests; correlation; and regression in SPSS (version 27; 2-sided α of .05). Results This protocol describes a study in its data collection phase. The study received ethics approval on September 1, 2025 (MRC-01-25-782), and it is funded by the Hamad Medical Corporation Medical Research Center (funding awarded in January 2026). Screening of eligible participants who met the inclusion criteria started in June 2026. Recruitment is anticipated to commence in October 2026 and is expected to be completed by October 2027. The primary results are anticipated for publication in early 2028. No outcome data are available at the time of submission. Conclusions The study will generate local evidence on the relationship between skeletal and oral health in older women and will evaluate whether aMMP-8 PoCT can serve as a practical, noninvasive screening adjunct in geriatric clinics. The findings are intended to inform integrated preventive and referral pathways in Qatar. Given the cross-sectional design, the study will characterize associations rather than establish causality.