Age and trabecular features of alveolar bone associated with osteoporosis

The use of visual assessment of dental radiographs for identifying women at risk of having osteoporosis: the OSTEODENT project

OBJECTIVE

The objective of this study was to investigate the diagnostic accuracy of visual assessment of the trabecular pattern in intraoral periapical radiographs to identify female subjects at risk of having osteoporosis.

STUDY DESIGN

Six hundred female subjects underwent intraoral periapical radiography of the maxillary and mandibular premolar region. Five observers assessed the trabecular pattern as dense, heterogeneous, or sparse, with the aid of reference images. All patients received a central dual energy x-ray absorptiometry (DXA) examination of the hip and lumbar spine.

RESULTS

With sparse trabecular pattern as indicative of osteoporosis, mean specificity was high (91.6 for the upper jaw and 90.8 for the lower jaw) while the sensitivity was low (28.2 for the upper and lower jaw). The mean intraobserver agreement was comparable for radiographs of the upper and lower jaw (median kappa(w) 0.53 and 0.57, respectively).

CONCLUSION

Visual assessment of the trabecular pattern in intraoral periapical radiographs of premolar regions is a potential method to identify women at risk of having osteoporosis.

Estrogen deficiency and its effect on the jaw bones

Estrogen deficiency-induced postmenopausal osteoporosis has become a worldwide problem, inducing low bone mass and microarchitectural deterioration of the bone scaffolding in the vertebrae and long bones. With the prevalence of such osteoporosis on the increase, the influence of this estrogen deficiency on the jaw bones has drawn the attention of researchers and clinicians in the field of dentistry. The aim of this article is therefore to review the microstructural changes occurring after ovariectomy in the jaw bones of animal subjects. Induced estrogen deficiency clearly led to structural changes in the jaw bones and alveolar bone of animal subjects (rats and monkeys). Severe bone loss in the rat alveolar bone was principally caused by high bone resorptive activity. This activity accelerated greatly immediately after ovariectomy, and was then followed by more moderate resorptive activity, which continued over an extended period. Additionally, occlusal hypofunction further greatly accelerated the fragility of the alveolar bone structure in ovariectomized rats. Microstructural damage also seen in the alveolar bone of ovariectomized monkeys was found to be directly connected to their systemic osteoporosis. Recent investigations of the relationship in humans between systemic osteoporosis and jaw bone loss have also suggested that a connection may exist between these two. However, more research is required to confirm this connection in humans as well.

A review of the association between osteoporosis and alveolar ridge augmentation

OBJECTIVE

Because of increasing life expectancy and popularity of dental implants, surgeons face a larger number of osteoporotic patients who require bone augmentation. Relationship between low bone density/osteoporosis and bone graft success is still not clear. The purpose of this article is to review and summarize the literature regarding the success of alveolar bone augmentation in osteoporosis.

STUDY DESIGN

The study design includes a literature review of relevant preclinical and clinical articles that address the association between osteoporosis and alveolar bone augmentation.

RESULTS

Increased rate of complications such as resorption of bone graft, non-integration of bone graft, delayed healing time, and implant failure in augmented bone especially in the maxilla may be associated with compromised bone health.

CONCLUSIONS

Despite the decreased success rate, osteoporosis is not an absolute contraindication for bone augmentation and dental implant placement. The modifiable risk factors for osteoporosis should be eliminated before surgery.

Assessment of mandibular buccal and lingual cortical bones in postmenopausal women

OBJECTIVE

Correlations between the widths of mandibular cortical bones and the bone mineral density (BMD) of the spine were analyzed to evaluate the influence of the general bone condition.

STUDY DESIGN

Thirty postmenopausal women were enrolled in this investigation. The widths of cortical bones in sites of the mental foramen and the BMD of the mandibular cancellous bone were measured using multislice computerized tomography (CT) images. The BMD of the lumbar spine was measured using dual-energy x-ray absorptiometry, and the ratio to the young adult mean (YAM) was obtained.

RESULTS

A weak correlation between the widths of cortical bones and the ratio to the YAM was observed. Also, correlations between the widths of cortical bones and the BMD of the mandible were noted.

CONCLUSION

The widths of buccal and lingual cortical bones in the mesial and distal sites of the mental foramen measured on axial CT images do not serve as a reliable examination for the BMD of the lumbar spine.

Skeletal bone mineral density in relation to thickness, bone mass, and structure of the mandibular alveolar process in dentate men and women

Peri-apical radiographs have been used to identify women with low bone mineral density (BMD) in various parts of the skeleton, but their usefulness for men has not been elucidated. The aim of this study was to test if the mandibular bone structure and bone mass in men and women were related to the BMD of the forearms, determined by dual X-ray absorptiometry, in 42 men and 42 women (aged 18-84 yr). Mandibular alveolar thickness was measured in casts, and alveolar 'bone mass' was estimated on digital radiographs using gray-shade distribution. Alveolar bone structure was evaluated visually (trabecular pattern) on analog radiographs and with its bone texture on digitized radiographs. Bone texture was correlated to BMD in both men and women. BMD was correlated to alveolar bone mass and trabecular pattern in women, but not in men. Bone texture and body mass index (BMI) explained 57% of the variance in BMD for men, whereas trabecular pattern and age explained 50% of the variance in BMD for women. Sparse trabeculation was associated with osteopenia. We conclude that alveolar bone texture and BMI are predictors of BMD for men, and age and trabecular pattern are predictors of BMD for women.