Relationship between the mandibular cortical index and calcaneal bone mineral density in postmenopausal women

Is there a correlation between radiographic absorptiometry of the phalanges of the hand and radiomorphometric indices of the mandible?

OBJECTIVES

The aim of this study was to correlate the mandibular bone quality through radiomorphometric indices in panoramic radiograph with bone quality of non-dominant hand phalanges by radiographic absorptiometry phalanx (RA).

METHODS

The sample consisted of 167 patients (128 women and 39 men) with a mean age of 52.09 (± 11.5) divided into four groups according to RA test: (A) 92; (B) 36; (C) 25 and (D) with 14.9. A panoramic radiograph was taken of each patient and one observer made measurements of cortical thickness at the mental foramen (mental index, MI) and gonion (goniac index, GI) regions and fractal dimension (FD) analyze in mandibular ramus. In phalangeal radiograph was made measurements of cortical thickness at the intermediate (medial phalange index, MPI) and proximal (proximal phalange index, PPI) phalangeal.

RESULTS

The results showed correlation (p < 0.00037) between Klemetti index with RA. Variance analysis MI, GI, MPI, PPI shown significant differences (p < 0.05) between the two groups (normal and low bone mineral density - BMD). Area under the ROC curve was 0.74 (sensitivity = 97.4%, specificity = 78%) for MI, 0.79 (sensitivity = 94, specificity = 54%) for GI, 0.77 (sensitivity = 94.8%, specificity = 64%) for MPI, 0.76 (sensitivity = 93.1%, specificity = 62%) for PPI, 0.71 (sensitivity = 96.5%, specificity = 86%) for FD.

CONCLUSIONS

Our results suggest that the analysis of radiomorphometric indices showed moderate accuracy for detecting changes in mandibular bone quality according to AR.

Transcriptomic analysis the mechanisms of anti-osteoporosis of desert-living Cistanche herb in ovariectomized rats of postmenopausal osteoporosis

Desert-living Cistanche herb (DC), as a traditional Chinese medicine for tonifying kidney yang, is often used to treat postmenopausal osteoporosis (PMOP). Total phenylethanoid glycosides are instruction ingredients for discrimination and assay according to the China pharmacopoeia for DC. This research aimed to reveal the anti-osteoporosis mechanism of total phenylethanoid glycosides of DC (PGC) by transcriptomic analysis of ovariectomized rats. Serum levels of BGP were evaluated by ELISA, the bone weight was measured, and transmission electron microscopy was used to examine the ultrastructure of osteoblasts in rats. In addition, micro-CT was used to detect the bone volume (Tb.BS/BV), bone mineral density (Tb.BMD), and bone mineral content (Tb.BMC) in trabecular bone, and the ratio of cortical bone area to total area (Ct.ar/Tt.ar), and the level of bone mineral content (Ct.BMC) in cortical bone. Differential expressed genes (DEGs) after PGC treatment were analyzed by transcriptomics. Then, a bioinformatics analysis of DEGs was carried out through GO enrichment, KEGG enrichment, and selection of the nucleus gene through the protein-protein interaction network. Through qRT-PCR analysis, the DEGs were verified. The analysis results indicated that PGC increased the secretion of osteogenic markers, and ultrastructural characterization of osteoblasts and bone morphology were improved in ovariectomized rats. A total of 269 genes were differentially expressed, including 201 genes that were downregulated and 68 genes that were upregulated between the model group and the PGC group. Bioinformation analysis results prompt the conclusion that PGC could promote the bone metabolism by muscle cell development, myofibril assembly, etc. In addition, our study also found that PGC has a good effect on osteoporosis complicated with cardiomyopathy, and it also provided evidence for the correlation between sarcopenia and osteoporosis.

Features of mandibular cortical bone morphology in osteoporotic fracture patients

PURPOSE

The diagnostic criteria for osteoporosis are based on the bone mineral density (BMD) level in the lumbar spine and femur bone. Patients with osteoporotic fractures were diagnosed with osteoporosis. While systemic BMD and mandibular cortical bone morphology are correlated, this has not been studied in patients with a history of osteoporotic fractures. Therefore, purpose of this study was researching the mandibular cortical bone morphology in patients with osteoporotic fractures.

METHODS

The subjects were 55 female and 20 male patients with osteoporotic fractures. Patients were divided into 30 primary osteoporosis patients and 45 secondary osteoporosis patients according to the medical history. Patients underwent BMD and panoramic radiography examinations during orthopedic treatment for fractures. A dual-energy X-ray absorptiometry system was used to measure BMD. Mandibular cortex index (MCI) and mandibular cortex width (MCW) were evaluated using machine-learning measurement software.

RESULTS

In the analysis of MCI, the ratio of class 2 and 3 was 73% of both primary osteoporosis and secondary osteoporosis. The average MCW was 2.19 mm for primary osteoporosis and 2.30 mm for secondary osteoporosis. The sensitivity values by MCI and MCW were 73% and 76% for both primary and secondary osteoporosis, which were similar detection powers. In addition, the false-negative rates by MCI and MCW were 27% and 24%.

CONCLUSION

We suggested that MCI and MCW are indicators of osteoporotic conditions in patients with primary and secondary osteoporosis. Our results show that MCI and MCW are non-inferior to the sensitivity values for lumbar BMD in patients with osteoporotic fractures.

Panoramic Indices: An Aid to Early Detection of Patients with Low Bone Mineral Density

Objective An early identification of patients who are at an obvious increased risk of osteoporosis and subsequent high risk of pathological bone fractures is important to prevent morbidity and its subsequent impact on the quality of life of the affected patients. Dental professionals have a chance of identifying such cases in their very initial stages through routinely prescribed dental radiographs. The aim of this study was to assess the influence of gender and age on different parameters of alveolar bone loss using orthopantomograph (OPG) as an aid to identify patients with low bone mineral density (BMD).

Materials and Methods This study included eighty subjects in whom after taking OPGs, mandibular cortical index (MCI), mandibular cortical width (MCW), and panoramic mandibular index were assessed, while the results obtained were subjected to statistical analysis. One-way analysis of variance followed by Tukey's test was used to compare the means, while p-value less than 0.05 was considered statistically significant.

Results The findings of this study revealed a significant association between MCI and age for females, with C2 and C3 categories being more common with advancing age. Also, a significant difference could be seen in relation to gender (p-value = 0.0315) for MCW with a concomitant decrease in the values of MCW in females over 60 years of age.

Conclusion Panoramic radiographic measurements could provide valuable information and help in screening patients with low BMD.

Mandibular cortical index in the screening of postmenopausal at low mineral density risk: a systematic review

OBJECTIVES

This systematic literature review addressed the use of mandibular cortical index (MCI), assessed by panoramic radiography, for the identification of postmenopausal women at risk of osteoporosis.

METHODS

Databases were searched for original research studies published from September 2010 to September 2020 using the following keywords: "postmenopausal osteoporosis" and synonyms combined with "panoramic radiography" and synonyms. Only English language manuscripts and studies pertaining to the MCI were selected.

RESULTS

A total of 24 studies were included. The publications were highly heterogeneous in terms of the subject of interest, i.e. the MCI, with some studies comparing the usefulness of the MCI using panoramic radiography and using cone beam computed tomography, and others comparing different radiomorphometric indexes developed for panoramic radiography.

CONCLUSIONS

Based on the literature included in this systematic review, we conclude that the MCI is useful as an auxiliary tool for identifying postmenopausal females at risk of low bone mineral density (BMD), as it correlates with skeletal BMD measured by dual X-ray absorptiometry. Nevertheless, other radiomorphometric indexes obtained from panoramic radiographs, such as panoramic mandibular index, mental index, and mandibular cortical width, are also valuable as auxiliary tools in the identification of postmenopausal females at risk, as they also correlate with BMD. Thus, it is not possible to affirm which index is the most reliable for the identification of postmenopausal females considering the literature screened. PROSPERO registration systematic review CRD42020208152.

Clinical guidelines for the application of panoramic radiographs in screening for osteoporosis

Osteoporotic fractures are associated with an increased risk of subsequent fractures, a higher rate of mortality, and incremental medical costs. Incidental findings, which include some measurements related to the mandibular inferior cortex and the alveolar trabecular bone pattern of the mandible determined on panoramic radiographs, are considered to be a useful tool for identifying asymptomatic individuals at risk of having osteoporosis and/or fragility fractures. We undertook a worldwide literature survey and present the following clinical recommendations. Postmenopausal female dental patients with a mandibular inferior cortical width of less than 3 mm on panoramic radiographs may be at risk of having low skeletal bone mineral density (BMD) or osteoporosis, but not fragility fractures. In addition, those with a severely eroded mandibular inferior cortex may have an increased risk of having low skeletal BMD, osteoporosis, and fragility fractures. The alveolar trabecular bone pattern of the mandible might be useful for identifying female dental patients at risk of having fragility fractures, although further investigation is necessary to confirm this possibility. These incidental findings on panoramic radiographs, when used for identifying asymptomatic postmenopausal female patients at risk of having osteoporosis in general dental practice, may be helpful in reducing the incidence of first fractures, with a consequent reduction in the secondary fractures, medical costs, and mortality associated with osteoporotic fragility fractures, without incurring any additional cost.

Assessment of alveolar bone mass using radio morphometric indices in urban and rural postmenopausal women and their correlation with serum vitamin D3 level

Introduction

The number of women with osteoporosis i.e. with reduced bone mass and disruption of bone architecture, is increasing in India due to severe deficiency of Vitamin D. It has been reported throughout the country in urban and rural post-menopausal women. Vitamin D synthesis is affected by geographical location, atmospheric pollution, clothing, melanin pigmentation and sunlight exposure. Moreover, ageing is also associated with decreased vitamin D synthesis. Vitamin D deficiency is the most underdiagnosed medical condition in postmenopausal woman.

Objective

Therefore, this study was planned to estimate and to evaluate alveolar bone mass using radio morphometric indices in postmenopausal women and its correlation with serum vitamin D3.

Materials and Methods

We conducted a study comprising of a study group of 60 post-menopausal women, divided into 2 sub-groups, each group comprising of 30 individuals, depending on their occupation and domicile. Blood samples were taken to evaluate serum vitamin D3 level. Also, panoramic radiographs of all the study subjects were recorded for evaluation of 3 radio morphometric indices viz. mandibular cortical index (MCI), mental index (MI), and panoramic mandibular index (PMI).

Results

Statistical analysis revealed higher significant values in rural than in urban postmenopausal woman.

Conclusions

A high overall prevalence (90%) of vitamin D deficiency was also observed in the study subjects.