Dentists' knowledge about osteoporosis and their ability to identify the disease

Are Radiographic Changes in the Mandibular Canal Associated With Bone Mineral Density?

BACKGROUND

Osteoporosis, highly prevalent among postmenopausal women, significantly reduces bone density and increases the risk of fractures. Cortical bone, which constitutes the largest calcium deposit in the human skeleton, is primarily affected in various conditions, including osteoporosis. Due to its visibility in panoramic radiography, the cortical area of the mandibular canal could be valuable in assessing decreases in bone mineral density (BMD).

PURPOSE

The study aimed to characterize and compare changes in the cortices of the mandibular canal between normal, osteopenic, and osteoporotic postmenopausal women.

STUDY DESIGN, SETTING, SAMPLE

Our cross-sectional study analyzed postmenopausal patients. We included only patients with panoramic radiographs with good quality and who underwent osteoporosis risk assessment by dual-energy x-ray absorptiometry (DXA).

INDEPENDENT VARIABLE

BMD was measured by DXA at 3 sites (spine, femur, and forearm) and used to classify the patients into normal, osteopenic, or osteoporotic. This classification remained consistent across all measurement sites.

MAIN OUTCOME VARIABLE

The main outcome variable was BMD of the mandibular canal cortices measured using black pixel intensity.

COVARIATES

Demographic covariates, including age, weight, height, and BMD, were assessed.

ANALYSES

One-way analysis of variance between groups considering a P < .05. The relationship between covariates and dependent variables was assessed using the Pearson correlation test.

RESULTS

The sample comprised 52 postmenopausal women aged more than 40 years (mean age 61 ± 10 years), 26 (50%) normal, 18 (35%) osteopenic, and 8 (15%) osteoporotic. Significant differences were observed in the percentage of black pixels in the mandibular ramus between the groups. In this region, the average percentage of black pixels was 3.19% (± 0.65) for the normal group, 2.78% (± 0.65) for the osteopenia group, and 2.35% (± 0.65) for the osteoporosis group (P = .015). No significant differences were found in other mandibular regions.

CONCLUSION AND RELEVANCE

Our findings demonstrate an association between BMD assessed in the mandibular canal cortex and the presence of osteoporosis as determined by DXA. While the observed differences in black pixel percentages in the mandibular ramus are minor, they are statistically significant, suggesting that panoramic radiography may serve as an adjunctive tool for osteoporosis screening.

The Correlation of Mineral Density of Jaws With Skeletal Bone and Its Effect on Implant Stability in Osteoporotic Patients: A Review of Patient-Based Studies

Osteoporosis has been an enigma in terms of the administration of implant therapy. It has been implicated as a cause of implant failure as it directly affects the quality of the bone. The diagnosis of osteoporosis is mainly done by measuring skeletal bone mineral density (BMD). During implant therapy, the BMD of jaws can be evaluated on routine orthopantomogram (OPG) or cone beam CT (CBCT). The various advantages of CBCT include establishing a correlation between skeletal bone density and bone density of jaws and estimating its effect on implant stability in osteoporotic patients, which in turn will help in determining the prognosis of the implant in osteoporotic patients. This review is a summary of all patient-related studies conducted in the mentioned context of implant placement in patients with osteoporosis, treatment modalities, and prognosis. We performed a search of relevant articles on Google Scholar, PubMed, and Cochrane, which yielded a total of 25 articles for full-text reviews. After excluding some articles based on the exclusion criteria, a review was conducted along with a pilot study on implant placement in osteoporotic patients. Regional bone density can be a helpful parameter in predicting primary implant stability and it can be a useful indicator of skeletal BMD. With a careful evaluation of BMD, dental implants can be placed in patients with osteoporosis with a better prognosis for the treatment.