Vitamin D, Calcium, Alkaline Phosphatase, and Parathyroid Hormone in Patients with and without Chronic Periodontitis


Alkaline phosphatase
bone metabolism
clinical attachment level
parathyroid hormone
vitamin D


Introduction: Periodontal diseases comprise a group of inflammatory diseases caused by bacteria that colonise the tooth surface and infect surrounding soft tissues, ultimately leading to tooth loss. Vitamin D, calcium, alkaline phosphatase, and parathyroid hormone have role in bone metabolism both in health or in disease.

Objective: To compare serum Vitamin D, calcium, alkaline phosphatase, and parathyroid hormone levels in patients with generalised chronic periodontitis and healthy periodontium.

Methods: A cross-sectional analytical study was done in 80 patients visiting Department of Dental Surgery from July to December 2019. Clinical parameters measured were plaque index, gingival index, clinical attachment level, and pocket depth in the healthy periodontium and generalised chronic periodontitis. Blood investigation for serum Vitamin D, calcium, alkaline phosphatase (ALP), and parathyroid hormone (PTH) level were done. Data was analysed in SPSS v.16.

Results: Out of total 80 patients enrolled (mean age of 36.20±7.37 years), 40 (50%) patients had healthy periodontium and 40 (50%) had generalised chronic periodontitis. Mean levels of serum Vitamin D (P=0.006) and calcium (P=0.020) were significantly higher in chronic periodontitis patient compared to healthy controls while no significant intergroup differences were seen with respect to ALP (P=0.267) and PTH (P=0.351).

Conclusion: No significant differences were found in the levels of ALP and PTH between generalised chronic periodontitis and healthy patients and higher levels of Vitamin D and calcium were seen in generalised chronic periodontitis patients as compared to healthy patients.



Petersen PE, Baehni PC. Periodontal health and global public health. Periodontol 2000. 2012;60:7-14.

do Amaral Bastos J, de Andrade LCF, Ferreira AP, de Almeida Barroso E, de Castro Daibert P, de Sa Barreto PL, et al. Serum levels of vitamin D and chronic periodontitis in patients with chronic kidney disease. J Bras Nefrol. 2013;35(1):20-6.

Van der Velden U, Kuzmanova D, Chapple ILC. Micronutritional approaches to periodontal therapy. J Clin Periodontol. 2011;38(Suppl 11):142-58.

Mahalingam A, Ilango P, Suresh V, Perumal K, Kathiresan H. Evaluation of serum calcium levels in patients with periodontitis. Int J Curr Adv Res. 2017 Feb;6(2):2287-9.

Urhbom E, Jacobson L. Calcium and periodontitis: Clinical effect of calcium medication. J Clin Periodontol. 1984;11:230-41.

Abuduwali N, Lossdorfer S, Winter J, Kraus D, Guhlke S, Wolf M, et al. Functional characterization of the parathyroid hormone 1 receptor in human periodontal ligament cells. Clin Oral Invest. 2014;18(2):461-70.

Pinto JP, Goergen J, Muniz FW, Haas AN. Vitamin D levels and risk for periodontal disease: A systematic review. J Periodontal Res. 2018;53(3):298-305.

Pradhan S, Bhatta MK. Assessment of periodontal status of rural Nepalese population using the community periodontal index. J Nepal Dent Assoc. 2009;10(2):97-104.

Dietrich T, Joshipura KJ, Dawson-Hughes B, Bischoff-Ferrari HA. Association between serum concentrations of 25-hydroxyvitamin D3 and periodontal disease in the US population. Am J Clin Nutr. 2004;80:108-13.

Loe H. The gingival index, the plaque index and the retention index systems. J Periodontol. 1967;38(6):38-44.

Löe H, Silness J. Periodontal disease in pregnancy I. Prevalence and severity. Acta Odontol Scand. 1963;21(6):533-51.

Breslow R, Katz I. Relative reactivities of p-nitrophenyl phosphate and phosphorothioate toward alkaline phosphatase and in aqueous hydrolysis. J Am Chem Soc. 1968;90(26):7376-7.

Leary NO, Pembroke A, Duggan PF. Single stable reagent (Arsenazo III) for optically robust measurement of calcium in serum and plasma. Clin Chem. 1992 Jun 1;38(6):904-8.

Cinquanta L, Fontana DE, Bizzaro N. Chemiluminescent immunoassay technology: what does it change in autoantibody detection? Auto Immun Highlights. 2017 Dec 1;8(1):9-16.

Dietrich T, Nunn M, Dawson-Hughes B, Bischoff-Ferrari H. Association between serum concentrations of 25-hydroxyvitamin D and gingival inflammation. Am J Clin Nutr. 2005;82:575-80.

Van der Putten GJ, Vanobbergen J, Visschere LD, Schols J, deBaat C. Association of some specific nutrient deficiencies with periodontal disease in elderly people: A systematic literature review. Nutrition. 2009;25:717-22.

Laky M, Bertl K, Haririan H, Andrukhov O, Seeman R, Volf I, et al. Serum levels of 25-hydroxyvitamin D are associated with periodontal disease. Clin Oral Investig. 2016;21:1553-8.

Zhang X, Meng H, Sun X, Xu L, Zhang L, Shi D, et al. Elevation of vitamin D-binding protein levels in the plasma of patients with generalized aggressive periodontitis. J Periodontal Res. 2013 Feb;48(1):74-9.

Nishida M, Grossi SG, Dunford RG, Ho AW, Trevisan M, Genco RJ. Calcium and the risk for periodontal disease. J Periodontol. 2000;71:1057-66.

Garcia MN, Hildebolt CF, Miley D, Dixon D, Coutture RA, Anderson-Spearie CL, et al. One-year effects of vitamin D and calcium supplementation on chronic periodontitis. J Periodontol. 2011;82:25-32.

Lundgren S, Rosenquist JB. Short term bone healing in calcium deficiency osteopenia and disuse osteopenia: experimental studies in adult rats. Scand J Dent Res. 1992;100(6):337-9.

Pushpa Rani DS, Anandan SM. A clinical study of serum alkaline phosphatase and calcium level in type 2 diabetes mellitus with periodontitis among the south Indian population. SRM J Res Dent Sci. 2012;3:175-9.

Antonoglou GN, Knuuttila M, Niemelea O, Yleostalo P, Raunio T, Hiltunen L, et al. Serum parathyroid hormone and active vitamin D in chronic periodontitis. J Clin Periodontol. 2015;42:726-32.

Barros SP, Silva MA, Somerman MJ, Nociti FH. Parathyroid hormone protects against periodontitis-associated bone loss. J Dent Res. 2003;82:791-5.

Vasconcelos DF, Marques MR, Benatti BB, Barros SP, Nociti FH, Novaes PD. Intermittent parathyroid hormone administration improves periodontal healing in rats. J Periodontol. 2014;85:721-8.

Bashutski JD, Eber RM, Kinney JS, Benavides E, Maitra S, Braun TM, et al. Teriparatide and osseous regeneration in the oral cavity. New Engl J Med. 2010;363(25):2396-405.

Caula AL, Lira-Junior R, Tinoco EMB, Fischer RG. Serum creatinine and alkaline phosphatase levels are associated with severe chronic periodontitis. J Periodontol Res. 2015;50:793-7.

Gibert P, Tramini P, Sieso V, Piva MT. Alkaline phosphatase isozyme activity in serum from patients with chronic periodontitis. J Periodontol Res. 2003;38:362-5.

Pradhan S, Koirala PK. Alkaline phosphatase levels before and after nonsurgical periodontal therapy. J Nepal Soc Perio Oral Implantol. 2019;3(6):62-5.

Schulze-Spate U, Turner R, Wang Y, Chao RP, Schulze PC, Phipps K, et al. Relationship of bone metabolism biomarkers and periodontal disease: The osteoporotic fractures in men (MrOS) study. J Clin Endocrinol Metab. 2015;100(6):2425-33.