Malakam C.Lertpimonchai A.Sritara C.Sritara P.Charatkulangkun O.Thongmung N.Mongkornkarn S.Mahidol University2026-04-292026-04-292026-01-01Journal of Periodontology (2026)00223492https://repository.li.mahidol.ac.th/handle/123456789/116404Background: No longitudinal evidence exists linking the trabecular bone score (TBS), a novel index of bone quality, to periodontitis. This 5-year retrospective cohort study explored the relationship between TBS and periodontitis progression in the Electrical Generating Authority of Thailand (EGAT) population, with a focus on postmenopausal women. Methods: Baseline mean TBS values of 617 participants aged 30–80 years were assessed from dual-energy x-ray absorptiometry (DXA) images of L1–L4 lumbar spines and classified as normal, partially degraded, or degraded TBS groups. At baseline and at 5-year follow-up surveys, the participants received full-mouth periodontal examinations. Periodontitis progression was defined as an additional ≥3 mm loss of proximal clinical attachment level (CAL) or the loss of a tooth with a baseline proximal CAL of ≥5 mm. Changes in periodontal parameters among the TBS groups were analyzed using the Kruskal-Wallis and Mann-Whitney U tests. The effects of TBS status on periodontitis progression were analyzed using multivariate Poisson regression. Results: Compared with the normal TBS group, participants with degraded TBS had a higher median number of teeth with periodontitis progression—approximately one additional tooth in the entire study population and two additional teeth in postmenopausal women. In the postmenopausal subgroup, degraded TBS was associated with a higher number of teeth with periodontitis progression, with an adjusted risk ratio of 1.85 (95% CI: 1.22–2.81). Conclusions: Degraded TBS is associated with an increased number of teeth with periodontitis progression in postmenopausal women. Early diagnosis and interdisciplinary collaboration between dental and medical professionals may help to mitigate progression in this population. Plain Language Summary: Gum disease (also called periodontitis) is a long-term condition that damages the tissues and bone supporting the teeth. Poor bone quality may be associated with an increased risk of gum disease progression. Bone quality can be measured using the trabecular bone score (TBS), which reflects the structural characteristics of bone rather than bone density. This study followed 617 Thai adults over 5 years to assess the link between bone quality and worsening gum disease. Disease progression was defined as a major loss of tooth support or the loss of a tooth that was already severely affected. Individuals with poor bone quality (degraded TBS) had, on average, one additional tooth with disease progression compared with those with normal bone quality. Among women after menopause, about two additional teeth were affected, and these women were nearly twice as likely to have more teeth with worsening gum disease. These findings suggest an association between decreased skeletal bone quality and a higher risk of gum disease. Early detection of weak bone quality, combined with proper oral care, may help to slow disease progression and to improve quality of life.DentistryArticleSCOPUS10.1002/jper.701262-s2.0-10503600617519433670