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We investigated the effect of oral alendronate (ALN) treatment on radiological and clinical measurements of periodontal disease in postmenopausal women without hormone replacement therapy.We evaluated the effect of 6 months of ALN treatment in 40 postmenopausal women, 55 to 65 years old with established periodontal disease, in a controlled, double-masked, prospective study. Volunteers were paired by age and randomized to receive ALN (10 mg/day) or placebo for the study period. Periodontal mechanical treatment was carried out in both groups. At baseline and after treatment, clinical evaluation, hormone blood levels, distance from the crestal alveolar bone (CAB) to the cemento-enamel junction (CEJ), calcaneus bone mineral density (BMD), hormone levels, serum N-telopeptide (NTx), and bone-specific alkaline phosphatase (BSAP) were assessed.Periodontal disease conditions improved in both groups, but greater improvement in probing depth (-0.8 ±0.3 mm versus -0.4 ±0.4 mm, P = 0.02) and gingival bleeding (-0.3% ± 0.13% versus -0.2% ±0.06%, P=0.006) was found in the ALN treated group. Calcaneus BMD increased in the ALN treated group (68 ±47 mm3 versus -26 ±81 mm3, P = 0.0006). CAB-CEJ distance diminished in the ALN group (-0.4 ±0.40 mm versus 0.60 ± 0.53 mm, P = 0.00008). Marginal reduction in both NTx and BSAP levels was found in the ALN group (-9.4 ± 6.6 nmol versus -4.3 ± 4.7 nmol bone collagen equivalents, P = 0.08, and -7.7 ± 8.4 versus -1.5 ± 5.0 U/l, P = 0.1, respectively). Hormone levels were unchanged after treatment. Similar improvement of calcaneus BMD and CAB-CEJ distance with ALN treatment was found in obese and non-obese women.ALN treatment improved periodontal disease and bone turnover in postmenopausal women. J Periodontol 2004; 75:1579-1585.