Three panoramic indices for identification of healthy older people at a high risk of osteoporosis

Y. Strut and radio-morphometric analysis of mandibular trabecular structure in pre-and post-menopausal women to aid in the diagnosis of osteoporosis

Purpose

The purpose of the study is to evaluate the mandibular trabecular pattern in pre- and postmenopausal age women. By analysing the strut, fractal, grey level co-occurrence matrix, and radio-morphometric indices in the panoramic radiograph.

Method

Panoramic radiographs from 2019 to 2022 were used to assess pre- and postmenopausal women's bone mineral density. A total of 272 panoramic radiographs, which exhibited clear visibility of the mental foramen on both sides without any blurring, motion artefacts, surgical errors, overlapping hyoid bone, or inferior mandibular cortex, were divided into two groups. Group A (136 premenopausal women) and Group B (136 postmenopausal women). It is a retrospective study that is non-interventional/observational in design. Strut features, fractal dimensions, a grey-level co-occurrence matrix, and radio morphometric indices were used to investigate bone texture in an image processing program. The mean difference between group variables was calculated using an independent sample t-test/unpaired t-test.

Results

Pre-menopausal women had a mean age of 38.83 ± 6.01 years, while postmenopausal women had a mean age of 68.26 ± 8.31 In the postmenopausal group Four regions of interest exhibited fractal dimensions with a P value of less than 0.01 and GLCM features including contrast (0.812), correlation (0.230), energy (0.215), and homogeneity (0.322). Strut features of the four regions showed that 15 of 19 characteristics were significantly different.

Conclusion

Orthopantomogram is useful in screening for osteoporosis. Strut, radio-morphometric indices, and fractal analysis can assess bone texture and quality. Future research incorporating artificial intelligence can revolutionize image analysis and support clinical decision-making.

Changes in mandibular radiomorphometric indices in osteoporosis patients treated with denosumab: a retrospective case-control study

BACKGROUND

Radiomorphometric indices measured on Dental Panoramic Radiography (DPR) can reflect Bone Mineral Density (BMD). The aim of our study is to evaluate changes in DPR radiographic markers in patients undergoing antiresorptive therapy with denosumab and correlate them to BMD and serum bone turnover markers (BTM).

METHODS

We evaluated two radiomorphometric indices: Mandibular Cortical Width (MCW) and Panoramic Mandibular Index (PMI), in patients undergoing antiresorptive therapy with denosumab at T0 (before starting the therapy) and at T1 (after 12 months), comparing results with a control group of healthy patients who performed two DPRs at a one-year time distance. Correlation analysis was performed in the denosumab group, as well as ROC curves were obtained for both indices.

RESULTS

The study included 18 patients and 21 controls according to specific inclusion and exclusion criteria, matched by gender and age. Both MCW and PMI were significantly lower at T0 in the denosumab group, consistently with lower BMD. MCW showed significant correlation with femoral and lumbar DEXA and was significantly lower in patients with osteoporosis compared to osteopenia. Only PMI index increased significantly in the denosumab group from T0 to T1. After one year (T1), there weren't any differences between patients and controls for both indices. No significant correlations were found with BTMs. Sensitivity and specificity for MCW and PMI were also calculated.

CONCLUSIONS

Our results show how CMW shows sufficient sensitivity and specificity to be used as a radiographic marker to screen and intercept patients with osteoporosis. PMI seems to be able to reflect changes in response to antiresorptive therapy with denosumab. Further studies are needed to confirm our hypothesis.

Evaluation of cortical and trabecular bone structure of the mandible in patients with ankylosing spondylitis

This study aimed to examine the difference between the fractal dimension (FD) values of the mandibular trabecular bone and the panoramic mandibular index (PMI), mandibular cortical index (MCI) and mandibular cortical thickness (MCW) of patients with ankylosing spondylitis (AS) and healthy control group. A total of 184 individuals (92 cases, 92 controls), were examined in our study. PMI, MCI, and MCW values were calculated on panoramic images of all individuals. For FD values, the region of interest (ROI) was selected with the size of 100 × 100 pixels from the right-left gonial and interdental regions and 50 × 50 pixels from the condylar region. Degenerative changes in the temporomandibular joint (TMJ) region were recorded. PMI, MCI, and MCW values showed statistically significant differences between the groups (p = 0.000, p < 0.001). The radiological signs of mandibular cortical resorption were more severe in the case group than in the control group. PMI and MCW values were found to be lower in the case group than in the control group. It was determined that the number of C3 and C2 values, among the MCI values, was higher in the case group. Only the FD values of the ROI selected from the condyle region were found to be statistically significant and were lower in the case group (p = 0.026, p < 0.05). Degenerative changes in the TMJ region were significantly more frequent in the case groups (p = 0.000, p < 0.001). The fact that the mandibular cortex shows more resorptive features in individuals with AS may require further evaluation in terms of osteoporosis. Because of the low FD values of the condylar regions of these patients and the more frequent degenerative changes, the TMJ region should be followed carefully. Detailed examination of the mandibular cortex and condylar region is beneficial in patients with AS for screening and following osteoporotic changes in these individuals, which is essential for the patient's life quality.

Correlations of the Osteoporosis Self-Assessment Tool for Asians (OSTA) and Three Panoramic Indices Using Quantitative Ultrasound (QUS) Bone Densitometry

This study aimed to evaluate the correlation between the Osteoporosis Self-Assessment Tool for Asians (OSTA) and three panoramic indices in relation to z-score and t-score values using quantitative ultrasound (QUS) bone densitometry. The sensitivity, specificity, and area under the curve (AUC) of the OSTA index were also measured using the QUS tool to evaluate the method's performance in identifying people at risk of osteoporosis. The study employed a cross-sectional design with 387 participants (190 men, 197 women). Patients' mandibular cortical indexes (MCI), mandibular cortical widths (MCW), and panoramic mandibular indexes (PMI) were measured from panoramic images. The sensitivity, specificity, and AUC were calculated using an OSTA index cutoff of ≤-1 and a t-score of ≤-1.0 for the QUS bone densitometry. The coefficient correlation of the OSTA index with the z-score (r = -0.563, p < 0.001) and t-score (r = -0.740, p < 0.001) shows a higher value than the MCI, MCW, and PMI, per the QUS. The sensitivity, specificity, and AUC values with a cutoff t-score of ≤-1.0 per the QUS in men was 90%, 50%, and 0.812, and in women, 96.8%, 30%, and 0.862. The OSTA index is a simple method that can be used in general dental practice.