Risk of vertebral osteoporosis in post-menopausal women with alterations of the mandible

Occlusal force orchestrates alveolar bone homeostasis via Piezo1 in female mice

Healthy alveolar bone is the cornerstone of oral function and oral treatment. Alveolar bone is highly dynamic during the entire lifespan and is affected by both systemic and local factors. Importantly, alveolar bone is subjected to unique occlusal force in daily life, and mechanical force is a powerful trigger of bone remodeling, but the effect of occlusal force in maintaining alveolar bone mass remains ambiguous. In this study, the Piezo1 channel is identified as an occlusal force sensor. Activation of Piezo1 rescues alveolar bone loss caused by a loss of occlusal force. Moreover, we identify Piezo1 as the mediator of occlusal force in osteoblasts, maintaining alveolar bone homeostasis by directly promoting osteogenesis and by sequentially regulating catabolic metabolism through Fas ligand (FasL)-induced osteoclastic apoptosis. Interestingly, Piezo1 activation also exhibits remarkable efficacy in the treatment of alveolar bone osteoporosis caused by estrogen deficiency, which is highly prevalent among middle-aged and elderly women. Promisingly, Piezo1 may serve not only as a treatment target for occlusal force loss-induced alveolar bone loss but also as a potential target for metabolic bone loss, especially in older patients.

Radiomorphometric indices of the mandible as indicators of decreased bone mineral density and osteoporosis - meta-analysis and systematic review

This review aims to evaluate the accuracy of various mandibular radiomorphometric indices in comparison with DEXA BMD measurements in the diagnosis of osteopenia and osteoporosis based on a meta-analysis of the sensitivity and specificity of the indices. PRISMA statement was followed. The materials for analysis were collected in August 2023 by searching three databases: PubMed Central, Web of Science, and Scopus. The selection of studies consisted of three selection stages, and 64 articles were finally obtained. Quality assessment was performed with the QUADAS-2 tool, and the general methodological quality of retrieved studies was low. Statistical analysis was performed based on 2 × 2 tables and estimated sensitivity and specificity were obtained using SROC curves. The most used indices were MCI, MCW and PMI. The best results in detecting reduced BMD obtained for MCW ≤ 3 mm, estimated sensitivity and specificity were 0.712 (95% CI, 0.477-0.870) and 0.804 (95% CI, 0.589-0.921), respectively. The most prone to the risk of bias is the MCI due to the examiner's subjectivism. Radiomorphometric indices of the mandible can be useful as a screening tool to identify patients with low BMD, but should not be used as a diagnostic method. Further research needs to focus on analysing the ability of the indices to detect osteoporosis and also in combination the indices with clinical parameters.

Application of Panoramic Radiography in the Detection of Osteopenia and Osteoporosis-Current State of the Art

PURPOSE OF REVIEW

Osteoporosis ranks high among morbidities in the elderly as it is a natural process to lose bone, making them susceptible to fractures from minor falls. The cost of managing these patients is staggering. The fractures can be prevented with better care of the elderly, and by treating the major predisposing factor, osteoporosis. Clinicians and scientists, in general, constantly look for early diagnostic and prognostic indicators for osteopenia and osteoporosis to proactively prevent fractures. Dental panoramic radiography (DPR) is a rotational pantomography used for identifying dental pathology in patients. Early signs of osteopenia and osteoporosis can be identified in DPR. The usefulness of notable jaw changes in DPR to predict osteopenia and osteoporosis is still evolving as more studies continue to delve into this concept. The purpose of this review is to present advances made in the practical application of DPR for predicting early onset of osteopenia and osteoporosis.

RECENT FINDINGS

Dental panoramic radiography, a form of tomography commonly used by dental practitioners, has been the standard of care for decades for detecting dento-alveolar pathology. Several technological advancements have taken place with respect to the use of DPR. These include conversion from plain film to digital radiography, advancements in the manufacture of flat panel detectors, and accurate imaging of the layers of mandible and maxilla that has become possible with appropriate patient positioning within the focal trough of the machine. Improvements in the software infrastructure make it easier to view, enhance, and save the radiographic images. The radiographic appearance of the trabecular bone within the mandible and indices measured from the dental panoramic radiographs focusing on the inferior cortex of the mandible are considered useful tools for identifying asymptomatic individuals with osteoporosis or at risk for developing osteoporosis. These indices apparently correlate with risks of fragility fractures of osteoporosis in other parts of the body. Dental panoramic radiography (DPR) is a commonly used radiographic procedure in dentistry for evaluation of teeth and associated maxillofacial structures. The evaluation of the inferior border of the mandible for reduction or loss of cortical thickness and evaluation of the trabecular bone within the mandible are helpful markers for early signs of osteopenia to identify patients at risk for osteoporosis. This review focused on research advancements on practical application of DPR in early identification of osteopenia and osteoporosis.

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.

Osteoporosis screening support system from panoramic radiographs using deep learning by convolutional neural network

OBJECTIVES

This study was performed to develop computer-aided screening systems that could predict osteoporosis. The systems were constructed using panoramic radiographs of women aged ≥ 50 years through three types of deep convolutional neural networks (CNNs): Alexnet, VGG-16, and GoogLeNet; the performances of the constructed systems were evaluated.

METHODS

One oral radiologist classified 1500 panoramic radiographs into three types. In C1, the endosteal margin of the cortex was smooth and sharp, whereas porosities were observed in C2 and C3. The risks of osteoporosis were higher in C2 and C3 than in C1; C3 had the highest risk. This information was included with the images as training data; three CNNs were transfer trained. Using each trained CNN, the diagnostic accuracy was assessed using panoramic radiographs and bone mineral density inspection findings in the lumbar spine and femoral neck of 100 additional patients.

RESULTS

All CNNs exhibited relatively good agreement with the oral radiologist's judgement (86.0%-90.7%). The predictive results of the three systems for osteoporosis of the lumbar spine showed sensitivities of 78.3%-82.6%, specificities of 71.4%-79.2%, and accuracies of 74.0%-79.0%. The predictive results for osteoporosis of the femoral neck showed sensitivities of 80.0%-86.7%, specificities of 67.1%-74.1%, and accuracies of 70.0%-75.0%.

CONCLUSIONS

The constructed systems were generally more accurate than the previously developed conventional system. The new systems may facilitate osteoporosis prediction and prevent subsequent fractures by encouraging patients with suspected osteoporosis to undergo further inspections (e.g., dual-energy X-ray absorptiometry) and treatment.

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

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Three panoramic indices could be used to detect the risk of osteoporosis.

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Severely eroded mandibular cortex as a potent marker of osteoporosis.

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Low bone density may occur in older people under 65 years.

Background

This study aimed to identify whether healthy older adults are at a high risk of osteoporosis based on the association between the T-score values of bone mineral density (BMD) and three panoramic indices.

Materials and methods

All participants (50–64 years old) underwent calcaneal quantitative ultrasound (QUS) bone densitometry. In total, 371 panoramic images were included in the analysis. The mandibular cortical width (MCW), mandibular cortical index (MCI), and panoramic mandibular index (PMI) were the three parameters assessed. The data were examined using one-way analysis of variance or Kruskal–Wallis H and post hoc tests. Spearman’s rho was used to measure correlation coefficients.

Results

T-score distributions in the normal, osteopenia, and osteoporosis categories were 80 (21.6%), 236 (63.6%), and 55 (14.8%), respectively. T-scores were significantly related to age, MCW, PMI, and MCI (p < 0.001). Participants with osteopenia and a risk of progression to osteoporosis had an average MCW value of < 3.38 mm, a PMI of < 0.31, and an MCI class 2 and 3 distribution in 211 (56.9%) participants. The highest to lowest correlation coefficients with a significant relationship to the T-score were for age (r = -0.844), MCI (r = 0.456), MCW (r = 0.359), sex (r = 0.354), and PMI value (r = 0.292).

Conclusions

This study found that healthy older people with Class 3 MCI, an MCW < 3 mm, and a PMI ratio < 0.3 had a significant association with lower BMD T-scores on QUS and were at higher risk of osteoporosis.

Identification of osteoporosis using ensemble deep learning model with panoramic radiographs and clinical covariates

Osteoporosis is becoming a global health issue due to increased life expectancy. However, it is difficult to detect in its early stages owing to a lack of discernible symptoms. Hence, screening for osteoporosis with widely used dental panoramic radiographs would be very cost-effective and useful. In this study, we investigate the use of deep learning to classify osteoporosis from dental panoramic radiographs. In addition, the effect of adding clinical covariate data to the radiographic images on the identification performance was assessed. For objective labeling, a dataset containing 778 images was collected from patients who underwent both skeletal-bone-mineral density measurement and dental panoramic radiography at a single general hospital between 2014 and 2020. Osteoporosis was assessed from the dental panoramic radiographs using convolutional neural network (CNN) models, including EfficientNet-b0, -b3, and -b7 and ResNet-18, -50, and -152. An ensemble model was also constructed with clinical covariates added to each CNN. The ensemble model exhibited improved performance on all metrics for all CNNs, especially accuracy and AUC. The results show that deep learning using CNN can accurately classify osteoporosis from dental panoramic radiographs. Furthermore, it was shown that the accuracy can be improved using an ensemble model with patient covariates.

Osteoporosis and periodontal diseases - An update on their association and mechanistic links

Periodontitis and osteoporosis are prevalent inflammation-associated skeletal disorders that pose significant public health challenges to our aging population. Both periodontitis and osteoporosis are bone disorders closely associated with inflammation and aging. There has been consistent intrigue on whether a systemic skeletal disease such as osteoporosis will amplify the alveolar bone loss in periodontitis. A survey of the literature published in the past 25 years indicates that systemic low bone mineral density (BMD) is associated with alveolar bone loss, while recent evidence also suggests a correlation between clinical attachment loss and other parameters of periodontitis. Inflammation and its influence on bone remodeling play critical roles in the pathogenesis of both osteoporosis and periodontitis and could serve as the central mechanistic link between these disorders. Enhanced cytokine production and elevated inflammatory response exacerbate osteoclastic bone resorption while inhibiting osteoblastic bone formation, resulting in a net bone loss. With aging, accumulation of oxidative stress and cellular senescence drive the progression of osteoporosis and exacerbation of periodontitis. Vitamin D deficiency and smoking are shared risk factors and may mediate the connection between osteoporosis and periodontitis, through increasing oxidative stress and impairing host response to inflammation. With the connection between systemic and localized bone loss in mind, routine dental exams and intraoral radiographs may serve as a low-cost screening tool for low systemic BMD and increased fracture risk. Conversely, patients with fracture risk beyond the intervention threshold are at greater risk for developing severe periodontitis and undergo tooth loss. Various Food and Drug Administration-approved therapies for osteoporosis have shown promising results for treating periodontitis. Understanding the molecular mechanisms underlying their connection sheds light on potential therapeutic strategies that may facilitate co-management of systemic and localized bone loss.

Repercussions of osteoporosis on the maxillofacial complex: a critical overview

INTRODUCTION

We present here a literature review focusing on the repercussions of osteoporosis on the oral and maxillofacial complex. Osteoporosis is a silent metabolic disorder characterized by reduced bone mineral density (BMD), which can lead to bone fractures, particularly affecting elderly women. The prevalence of this disease has increased significantly worldwide, and since it accelerates bone resorption also in the jaw bones, some attention has been paid to possible oral and maxillofacial manifestations.

MATERIALS AND METHODS

The databases PubMed and Google Scholar were searched for reports of oral and maxillofacial changes related to osteoporosis.

RESULTS

Several parameters evaluating bone changes in panoramic radiography have been proposed to estimate osteoporosis-related BMD loss, but they tend to warn about the possibility of osteoporosis, rather than being diagnostic criteria. Meanwhile, it seems that osteoporosis-related BMD loss could delay alveolar bone healing and potentiate bone loss in periodontal disease.

CONCLUSION

Even though orofacial bones are not compromised by osteoporosis as much as the axial/appendicular skeleton, a regular dental follow-up of osteoporotic patients is advised, especially in the case of periodontal disease and maxillofacial surgery. Further controlled longitudinal studies considering the site-specificity of osteogenesis would be helpful regarding this issue.

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.

Computer-aided diagnosis system for osteoporosis based on quantitative evaluation of mandibular lower border porosity using panoramic radiographs

OBJECTIVES

A new computer-aided screening system for osteoporosis using panoramic radiographs was developed. The conventional system could detect porotic changes within the lower border of the mandible, but its severity could not be evaluated. Our aim was to enable the system to measure severity by implementing a linear bone resorption severity index (BRSI) based on the cortical bone shape.

METHODS

The participants were 68 females (>50 years) who underwent panoramic radiography and lumbar spine bone density measurements. The new system was designed to extract the lower border of the mandible as region of interests and convert them into morphological skeleton line images. The total perimeter length of the skeleton lines was defined as the BRSI. 40 images were visually evaluated for the presence of cortical bone porosity. The correlation between visual evaluation and BRSI of the participants, and the optimal threshold value of BRSI for new system were investigated through a receiver operator characteristic analysis. The diagnostic performance of the new system was evaluated by comparing the results from new system and lumbar bone density tests using 28 participants.

RESULTS

BRSI and lumbar bone density showed a strong negative correlation (p < 0.01). BRSI showed a strong correlation with visual evaluation. The new system showed high diagnostic efficacy with sensitivity of 90.9%, specificity of 64.7%, and accuracy of 75.0%.

CONCLUSIONS

The new screening system is able to quantitatively evaluate mandibular cortical porosity. This allows for preventive screening for osteoporosis thereby enhancing clinical prospects.

Evaluation of Transfer Learning with Deep Convolutional Neural Networks for Screening Osteoporosis in Dental Panoramic Radiographs

: Dental panoramic radiographs (DPRs) provide information required to potentially evaluate bone density changes through a textural and morphological feature analysis on a mandible. This study aims to evaluate the discriminating performance of deep convolutional neural networks (CNNs), employed with various transfer learning strategies, on the classification of specific features of osteoporosis in DPRs. For objective labeling, we collected a dataset containing 680 images from different patients who underwent both skeletal bone mineral density and digital panoramic radiographic examinations at the Korea University Ansan Hospital between 2009 and 2018. Four study groups were used to evaluate the impact of various transfer learning strategies on deep CNN models as follows: a basic CNN model with three convolutional layers (CNN3), visual geometry group deep CNN model (VGG-16), transfer learning model from VGG-16 (VGG-16_TF), and fine-tuning with the transfer learning model (VGG-16_TF_FT). The best performing model achieved an overall area under the receiver operating characteristic of 0.858. In this study, transfer learning and fine-tuning improved the performance of a deep CNN for screening osteoporosis in DPR images. In addition, using the gradient-weighted class activation mapping technique, a visual interpretation of the best performing deep CNN model indicated that the model relied on image features in the lower left and right border of the mandibular. This result suggests that deep learning-based assessment of DPR images could be useful and reliable in the automated screening of osteoporosis patients.

Correlation of Radiomorphometric Indices of the Mandible and Biochemical Parameters in Patients with Secondary Hyperparathyroidism Due to Chronic Kidney Disease

OBJECTIVE

 The aim was to correlate radiomorphometric indices and biochemical analyses as an auxiliary method in bone evaluation in male and female patients with chronic kidney disease-mineral and bone disorder (CKD-MBD) and controls.

MATERIALS AND METHODS

 Nine radiomorphometric indices and four biochemical parameters were obtained: mental index (MI), height at the mental foramen, total mandibular height (THM), panoramic mandibular index (PMI), original height of the mandible, alveolar bone resorption, distance from the mental foramen to the alveolar bone crest (MF-ABC), mandibular cortical index (MCI), trabecular bone pattern, parathyroid hormone (PTH), calcium (Ca), phosphorus (P), and Ca × P product (Ca × P).

STATISTICAL ANALYSIS

 The Mann-Whitney U-test, chi-squared test, and Spearman's correlation were applied at a significance level of 95%.

RESULTS

 There was a moderate negative and significant correlation between MI, PMI, and PTH in female patients with CKD-MBD as well as between THM, MF-ABC, and Ca × P. The MCI and trabecular bone pattern indicated altered bone quality in male patients.

CONCLUSIONS

 The radiomorphometric evaluation was an auxiliary, noninvasive method to detect possible alterations in the cortex and mandibular bone trabeculation in male and female patients with CKD-MBD.

Assessing periapical dental radiographs as a screening parameter for early indications of osteoporosis in postmenopausal periodontal patients and root surface evaluation using spectrochemical analysis

Objectives:

To assess the usefulness of periapical dental radiograph as a screening tool aimed at early signs of osteoporosis in postmenopausal periodontal patients and root surface evaluation using spectrochemical analysis.

Methods:

This study was conducted at the Department of Periodontics, Riyadh Elm University, Riyadh, Saudi Arabia, for 12 months between December 2016 and November 2017. Two groups consisted healthy postmenopausal women having chronic periodontitis and postmenopausal women having chronic periodontitis with osteoporosis. Osteoporosis were evaluated for plaque index (PI); gingival index (GI); clinical attachment level (CAL); probing pocket depth (PPD), and bone mineral density (BMD). A standardized digital dental periapical radiographs were taken for every patient. The spectrochemical analysis was carried out using the self-assembled Laser-Induced Breakdown Spectroscopy (LIBS) system used for qualitative and quantitative analysis of Calcium (Ca), Potassium (K), Phosphorus (P), Fluoride (F), and Magnesium (Mg)

Results:

There was no statistically significant difference between both groups for GI and PI. Similarly PPD and CAL were showing the difference but statistically, significant difference was only for CAL. Value of distance starting from cement enamel junction to the alveolar crest (CEJ-AC) and BMD were having a statistically significant variance between both groups. The differences between osteoporotic and control group were statistically significant regarding Ca with the mean higher in the control group. Furthermore, the variances between the groups in both K and Mg were statistically significant with higher mean in the osteoporotic group (p<0.05).

Conclusion:

The clinical, radiographic, and experimental findings of this study indicated that osteoporosis has a direct effect on the progression rate of periodontal tissue destruction and dental radiographic can be suggested as a screening tool for an early sign of osteoporosis.

Evaluating the possible association between systemic osteoporosis and periodontal disease progression in postmenopausal women

To evaluate the association between systemic osteoporosis and periodontal diseases in postmenopausal women. A total of 300 women aged (50-70 years) were divided into an osteoporotic (OP) group (n = 150) and non-osteoporotic (NOP) group (n = 150) depending on BMD measured using (DXA) at the femoral neck and lumbar spine. Periodontal examination including PI, GI, PPD, and CAL was measured. A standard digital dental panoramic radiograph was taken for each patient and analyzed using specially developed software graphic program to assess the alveolar bone level and BMD. Elemental analysis of root surfaces of extracted teeth was done for detecting Ca, P, F, Mg, and K using (LIBS). Results showed the differences between both groups were not statistically significant in PI, GI, and PPD. A statistically significant difference was found between both groups in CAL, the distance between CEJ-AC and alveolar bone density. Elemental analysis of the root surfaces revealed that Ca was statistically significantly less in the OP group while the differences between both groups regarding F and P were not statistically significant. Mg and K found to be significantly more in the OP group than in the NOP group. To conclude osteoporosis is certainly a risk factor for periodontal disease and seems to plays a vital role in disease progression.

Osteoporosis detection in panoramic radiographs using a deep convolutional neural network-based computer-assisted diagnosis system: a preliminary study

OBJECTIVES

To evaluate the diagnostic performance of a deep convolutional neural network (DCNN)-based computer-assisted diagnosis (CAD) system in the detection of osteoporosis on panoramic radiographs, through a comparison with diagnoses made by oral and maxillofacial radiologists.

METHODS

Oral and maxillofacial radiologists with >10 years of experience reviewed the panoramic radiographs of 1268 females {mean [± standard deviation (SD)] age: 52.5 ± 22.3 years} and made a diagnosis of osteoporosis when cortical erosion of the mandibular inferior cortex was observed. Among the females, 635 had no osteoporosis [mean (± SD) age: 32.8 ± SD 12.1 years] and 633 had osteoporosis (72.2 ± 8.5 years). All panoramic radiographs were analysed using three CAD systems, single-column DCNN (SC-DCNN), single-column with data augmentation DCNN (SC-DCNN Augment) and multicolumn DCNN (MC-DCNN). Among the radiographs, 200 panoramic radiographs [mean (± SD) patient age: 63.9 ± 10.7 years] were used for testing the performance of the DCNN in detecting osteoporosis in this study. The diagnostic performance of the DCNN-based CAD system was assessed by receiver operating characteristic (ROC) analysis.

RESULTS

The area under the curve (AUC) values obtained using SC-DCNN, SC-DCNN (Augment) and MC-DCNN were 0.9763, 0.9991 and 0.9987, respectively.

CONCLUSIONS

The DCNN-based CAD system showed high agreement with experienced oral and maxillofacial radiologists in detecting osteoporosis. A DCNN-based CAD system could provide information to dentists for the early detection of osteoporosis, and asymptomatic patients with osteoporosis can then be referred to the appropriate medical professionals.

Osteoporotic alterations in a group of different ethnicity Brazilian postmenopausal women: An observational study

OBJECTIVES

To compare peripheral bone mineral density alterations among Brazilian postmenopausal women from three ethnic groups considering age and body mass index influence; to correlate their bone mineral density with the mandibular cortical index (MCI); and to evaluate the influence of age, body mass index and ethnicity in the MCI using risk factor analysis.

BACKGROUND

Osteoporosis risk is known to have ethical influences. However, little is known about the differences in ethnicity in radiomorphometric indices.

MATERIALS AND METHODS

A total of 150 postmenopausal women with different ethnicities (Caucasian, Asian and Afro-descendant) who underwent peripheral dual X-ray absorptiometry and panoramic examination were included. Bone mineral density and MCI were assessed. Adjusted odds ratio analyses were performed on bone density and MCI considering the effect of age, ethnicity and body mass index. The correlations between the MCI and the dual X-ray absorptiometry results were made.

RESULTS

Old age, low body mass index and non-Afro-descendant were associated with low bone density. Compared with Afro-descendants, Asians and Caucasians have higher chances of having decreased bone mass. For the MCI, statistical analysis showed that age is the only variable associated with osteoporotic alterations in the mandible. Furthermore, an inverse correlation was found between the MCI and the T-scores.

CONCLUSION

Bone density is higher in Brazilian Afro-descendant women than in Caucasians and Asians. Patient's age is associated with bone density and the MCI. The mandibular cortical index is inversely correlated with the peripheral densitometry results within the study ethnic population.

Efficacy of Panoramic Radiography in the Detection of Osteoporosis in Post-Menopausal Women When Compared to Dual Energy X-Ray Absorptiometry

OBJECTIVE

It is a well-known fact that osteoporosis affects the people with old age and remains unnoticeable until the patient presents with fracture. Various studies in the literature reveal that panoramic radiographs may prove to be beneficial in the detection of Osteoporosis in patients. Henceforth this present study was aimed to validate the use of Klemetti Index (KI) on panoramic radiographs so as to detect osteoporosis in the patients at an early stage.

METHODS

60 postmenopausal women were selected. A panoramic radiograph was taken to grade their mandibular cortex on the basis of Klemetti Index. All the panoramic radiographs were evaluated by 5 different Oral Medicine and Radiology specialists. Later all the patients were subjected to dual energy X-ray absorptimetry (DEXA) scan for bone mineral density evaluation. The results were evaluated statistically.

RESULTS

The average accuracy of the five observers to demonstrate normal bone, osteopenia and osteoporosis when compared to DEXA scan was 58.08%, 63.3% and 64.74% respectively. The observations of the 5 observers on the basis of KI were not statistically different from the BMD evaluation done with the help of DEXA Scan.

CONCLUSION

Panoramic radiographs can be used as a screening tool for the evaluation as well as early detection of osteoporosis with the usage of Klemetti Index.

IDIOS: An innovative index for evaluating dental imaging-based osteoporosis screening indices

Purpose

The goal of this study was to develop a new index as an objective reference for evaluating current and newly developed indices used for osteoporosis screening based on dental images. Its name; IDIOS, stands for Index of Dental-imaging Indices of Osteoporosis Screening.

Materials and Methods

A comprehensive PubMed search was conducted to retrieve studies on dental imaging-based indices for osteoporosis screening. The results of the eligible studies, along with other relevant criteria, were used to develop IDIOS, which has scores ranging from 0 (0%) to 15 (100%). The indices presented in the studies we included were then evaluated using IDIOS.

Results

The 104 studies that were included utilized 24, 4, and 9 indices derived from panoramic, periapical, and computed tomographic/cone-beam computed tomographic techniques, respectively. The IDIOS scores for these indices ranged from 0 (0%) to 11.75 (78.32%).

Conclusion

IDIOS is a valuable reference index that facilitates the evaluation of other dental imaging-based osteoporosis screening indices. Furthermore, IDIOS can be utilized to evaluate the accuracy of newly developed indices.

Osteoporosis: Its Prosthodontic Considerations - A Review

Osteoporosis is a disease of bone which is common in middle aged post-menopausal women. The osteoporotic bones will become weak and are prone to fractures. Osteoporosis means "porous bone" is a "silent disease". Healthy bone microscopically appears like a honeycomb but, in osteoporotic patients the spaces are much bigger. The osteoporotic bone will have less density or mass and the structure of bone tissue is abnormal. As the bone becomes less dense, they become weaker and more likely to fracture. Women are four times more likely to develop osteoporosis than men. Oral health maintenance for adults with osteoporosis is important. Bone weakness and loss may also affect the ridges that hold dentures resulting in poor fitting dentures. The patients require new dentures more often than those who have strong, healthy bones. Best way to handle problems is avoid delaying or postponing the dental treatment. Regular dental visits and healthy lifestyle is necessary in strengthening and maintenance of good bone health. Well balanced diet with high amounts of vitamin-D & calcium with regular physical activity is recommended.

Mandibular inferior cortical bone thickness on panoramic radiographs in patients using bisphosphonates

OBJECTIVE

The goal of this study was to detect dimensional changes in the mandibular cortical bone associated with bisphosphonate (BP) use and to correlate measurements of the cortical bone with the cumulative dose of BPs.

STUDY DESIGN

Mandibular inferior cortical bone thickness (MICBT) was measured under the mental foramen on panoramic radiographs of patients with and without bisphosphonate-related osteonecrosis of the jaws (BRONJ) taking BPs and controls.

RESULTS

Patients with BRONJ had the highest mean MICBT (6.81 ± 1.35 mm), compared with patients without BRONJ taking BPs (5.44 ± 1.09 mm) and controls (4.79 ± 0.85 mm) (P < .01). Mean MICBT of patients with BRONJ was significantly higher than that of patients without BRONJ taking BPs. There was a correlation between MICBT and cumulative dose of zolendronate.

CONCLUSIONS

Measurement of MICBT on panoramic radiographs is a potentially useful tool for the detection of dimensional changes associated with BP therapy.

Prediction of low bone mass using a combinational approach of cortical and trabecular bone measures from dental panoramic radiographs

The aim of this study is to extract cortical and trabecular features of the mandible and to develop a novel combinational model of mandibular cortical thickness, trabecular bone area and age in order to predict low bone mineral density or osteoporosis from a dental panoramic radiograph. The study involved 64 south Indian women (age = 52.5 ± 12.7 years) categorised into two groups (normal and low bone mineral density) based on total femur bone mineral density. The dental panoramic radiographs were obtained by a digital scanner, and measurement of total bone mineral density at the right femur was performed by a dual-energy X-ray absorptiometry scanner. The mandibular cortical thickness and panoramic mandibular index were measured bilaterally, and the mean values were considered. The region of interest of 128 × 128 pixels around the mental foramen region was manually cropped and subjected to pre-processing, normalisation and average threshold-based segmentation to determine trabecular bone area. Multiple linear regression analyses of cortical and trabecular measures along with age were performed to develop a combinational model to classify subjects as normal and low bone mineral density. The proposed approach demonstrated strong correlation (r = 0.76; p < 0.01) against the total bone mineral density and resulted in accuracy, sensitivity and positive predictive values of 0.84, 0.92 and 0.85, respectively; the receiver operating characteristic outcomes disclosed that the area under the curve was 0.89.Our results suggest that the proposed combinational model could be useful to diagnose subjects with low bone mineral density.

Y, Rakesh N, Reddy SS, Santana N, Shetty N. Relationship between femur bone mineral density, body mass index and dental panoramic mandibular cortical width in diagnosis of elderly postmenopausal women with osteoporosis

OBJECTIVES

To measure and determine mandibular cortical width (MCW) on the panoramic radiographs, to evaluate the usefulness of the method in identifying postmenopausal women with low femoral bone mineral densities (f- BMD) and to correlate the radiographic findings on panoramic radiographs with the f-BMD assessed by dual X-ray absorptiometry (DXA) to predict the efficacy of the radiographic method in diagnosing osteoporosis.

MATERIALS AND METHODS

One hundred and twenty postmenopausal women (60 normal and 60 osteoporotic) in the age group of 50-75 y with f-BMD assessed by DXA had undergone panoramic radiographic examination. The patients were classified as normal (T-score ≥ -1.0) and osteoporotic (T-score ≤ -2.5). MCW on panoramic radiographs was measured bilaterally at the mental foramen region with a caliper and their mean was used as the exposure measure in the analysis.

RESULTS

Student t-test showed that mean f-BMD, BMI and MCW was found be less in osteoporotic patients as compared to normal group with a statistically significant p-value < 0.001. Pearson correlation coefficient test revealed that MCW correlated positively with f-BMD and showed a significant decrease with age of the patient.

CONCLUSION

Postmenopausal women with low f-BMD had thinner mandibular cortex at the mental foramen region when compared to normal subjects and are more susceptible to femoral neck fractures. Mandibular inferior cortical width at the mental foramen region could be used to identify postmenopausal women with low f- BMD. Hence, dental panoramic radiographs serve as a useful screening tool for early diagnosis of osteoporotic fractures.

Digital panoramic radiographs are useful for diagnosis of osteoporosis in Korean postmenopausal women

OBJECTIVE

The purpose of this study was to determine whether digital panoramic radiographs could be used for the diagnosis of osteoporosis through evaluation of the radiographs based on the correlation with bone mineral density (BMD).

METHODS

One hundred and ninety-four post-menopausal women were selected from participants who had participated in the Dong-gu study. Panoramic radiographic indices measured are mental index (MI), mandibular cortical index (MCI) and simple visual estimation (SVE). BMD at the lumbar spine and proximal femur was measured by dual-energy X-ray absorptiometry (DXA). The Pearson's correlation test was performed to analyse the correlation between MI and age and BMD at the lumbar spine, femoral neck and total hip. Multiple linear regression analysis was performed to analyse the association of MI, MCI and SVE with BMD after adjusting for age, height and weight. To determine the optimal cut-off point of MI for the diagnosis of osteoporosis, the receiver operating characteristic analysis was performed.

RESULTS

The MI was positively correlated with BMDs: lumbar spine: r = 0.36, femoral neck: r = 0.59 and total hip: r = 0.58 (p < 0.001). As age increased, MI decreased (r = -0.46). BMD at the lumbar spine and total hip were significantly lower in participants with reduction of mandibular width, thinning and resorption of mandibular cortex by the MI, SVE and MCI, respectively. The optimal cut-off value of MI for the diagnosis of spinal osteoporosis was 2.22 mm.

CONCLUSION

Thickness and morphological changes of mandibular inferior cortical bone are associated with BMD, independent of age, height and weight. These results suggest that MI, MCI and SVE may be useful indices for the diagnosis of osteoporosis in a Korean population.

Panoramic radiomorphometric indices as reliable parameters in predicting osteoporosis

BACKGROUND

The purpose was to evaluate the significance of panoramic radiomorphometric indices (mandibular cortical index [MCI], mental index [MI] and panoramic mandibular index [PMI]) as useful tools for identifying osteoporosis.

METHODS

One hundred healthy women aged ≥ 30 years were included. Digital panoramic images and bone mineral density (BMD) of the lumbar spines were recorded. Radiomorphometric indices (MCI, MI and PMI) were measured and categorized.

RESULTS

Interobserver agreements were kappa = 0.922 for the MCI and alpha = 0.902 and 0.702 for the PMI and MI, respectively. The indices MI, PMI and BMD showed a statistically significant positive correlation with the t score (r = 0.47, 0.36 and 0.96, respectively). The MI showed a statistically significant positive correlation with the PMI (r = 0.72). Sensitivity, specificity and diagnostic accuracy of the MI at a cutoff point of 4.5 mm were 76.9%, 54.1% and 63%, respectively, whereas for the MCI were 66.7%, 75.4% and 72%, respectively.

CONCLUSIONS

Panoramic indices (MI, PMI and MCI) were positively correlated with the t score and BMD of the lumbar spines. The MCI was found to be the most reproducible index.

Relationship between findings of mandibular cortical bone in inferior border and bone mineral densities of lumbar vertebrae in postmenopausal women

It is important to assess the general bone condition in dental implant treatment. The relationships between the bone mineral densities (BMDs) of lumbar vertebrae and mandibular cortical bone condition in the inferior border using multi-slice computed tomography (CT) were assessed in postmenopausal women. If a strong correlation between them is obtained, the mandibular cortical bone condition may be useful to evaluate the general bone condition. Twenty-two postmenopausal women were enrolled in this investigation. The maximum CT value and width of the mandibular cortical bone (MCW-MSCT) were measured, and the mandibular cortical bone index (MCI-MSCT) was classified using multi-slice CT. BMDs of lumbar vertebrae were measured using dual energy X-ray absorptiometry (DXA), and then the percentage of the young adult mean (YAM) was analyzed. The correlations were investigated between the mandibular cortical bone condition and values of lumbar vertebrae. Weak correlations were observed between MCW-MSCT and the percentage of YAM. Also, significant differences in the percentage of YAM were noted between types of MCI-MSCT. The mandibular cortical bone index (MCI-MSCT) in the inferior border using multi-slice CT may be applicable to evaluate the influence of the general bone condition.

Evaluation of panoramic Radiographs as a Screening Tool of Osteoporosis in Post Menopausal Women: A Cross Sectional Study

BACKGROUND

Indian women, especially those from low-income groups consume diets that are deficient of calcium, proteins and micronutrients. Hence, they are prone to suffer from osteoporotic hip fractures at a much earlier age than western women. To detect early signs of osteoporosis, it is ideal to perform Bone Mineral Density testing of all post-menopausal women who are at risk.

AIM

(i) To assess and compare the relative efficacy, ease of application and measurement of the various mandibular cortical indices which were obtained on the panoramic radiographs with bone densitometry data of post-menopausal women. and (ii) To evaluate the effectiveness of these measurements in the identification of cases of osteoporosis/osteopaenia.

METHOD

A cross sectional sample which consisted of 40 randomly selected post menopausal women who were aged 40-69 years was subjected to dental panoramic radiography. Mental index, panoramic mandibular index, gonion index, mandibular cortical index and antegonial index were measured on each radiograph. The data were expressed as mean and standard deviation. Analysis of variance with post-hoc Tukey's test was performed to determine group differences in mandibular measurements.

RESULTS

Based on the bone densitometry results, the sample was classified into normal (n=9), osteopaenic (n=15) and osteoporotic (n=16) groups. Statistically significant differences were found for mean Mental index (p=0.000), mean Panoramic Mandibular Index (p=0.007) and mean Gonial Index (p=0.000). The sensitivity (100%) and specificity (88.88%) of MCI showed good results.

CONCLUSION

Dentists who use orthopantomographs may play a vital role in screening patients with osteoporosis, mainly among post menopausal women.

Estrogen deficiency reduces the dentinogenic capacity of rat lower incisors

Endogenous estrogen deficiency usually causes the systemic osteoporosis including the jaw bones. However, it remains unclear whether estrogen deficiency can affect the tooth mineralization. In this study, the classical osteoporotic rat model was established via the ovariectomy, which was subsequently confirmed by the detection of serum estradiol levels and body weights. The mineralization-related assays were performed to observe the potential changes in mineralized tissues of rat lower incisors. The clinical crown length, compressive strength, radiodensity, and calcium content in the ovariectomy group (OVX) were significantly downregulated (P < 0.01), as compared with the sham operation group (Sham). Histological results revealed that OVX incisors presented the thinner predentin structures than Sham incisors. Immunohistochemical staining and western blot assay further demonstrated that the odonto/osteoblast specific proteins (e.g., dentin sialoprotein, runt-related transcription factor 2, osterix, and osteocalcin) in the dentin–pulp complex of OVX incisors were significantly decreased in comparison with Sham counterparts. Together, estrogen deficiency reduces the dentinogenic capacity and calcium deposition in rat incisors, indicating that estrogen plays an important role in the dentinogenesis.

Diagnostic efficacy of panoramic radiography in detection of osteoporosis in post-menopausal women with low bone mineral density

Objective:

The aim of the study was to evaluate panoramic radiograph, a commonly taken dental radiograph as a screening tool to detect early osseous changes (normal, mildly or severely eroded) of the mandibular inferior cortex and measure the mandibular cortical width (CW) in post-menopausal women and correlate it with the bone mineral density (BMD) measured by the ultrasound bone sonometer at the mid-shaft tibia region.

Materials and Methods:

The study included females between 45 years and 65 years of age in their post-menopausal stage (no menstruation for at least 6-12 months). Mandibular indices (mandibular CW and mandibular cortical shape) were evaluated from panoramic radiographs. The BMD assessment was carried out at the mid-shaft tibia region, exactly half-way between the heel and the knee joint perpendicular to the direction of the bone, using an ultrasound bone sonometer. It is a non-invasive device designed for quantitative measurement of the velocity of ultrasound waves as speed of sound in m/s, capable of measuring bone density at one or more skeletal sites. Using 1994 WHO criteria the study subjects were categorized as Group 1: Normal, Group 2: Osteopenia, Group 3: Osteoporosis. (WHO T score for tibia BMD can be used as a standard).

Results:

The diagnostic efficacy of the panoramic radiograph in detecting osseous changes in post-menopausal women with low BMD was shown to have 96% specificity and 60% sensitivity with mandibular cortical shape and 58% specificity and 73% sensitivity with mandibular CW measurement. Factorial ANOVA analysis carried out indicated a significant correlation of BMD classification with mandibular cortical shape (F = 29.0, P < 0.001, partial eta squared [η²] =0.85), a non-significant correlation with mandibular CW, (F = 1.6, P = 0.23, η² = 0.86), and a more significant correlation with combined cortical shape and width (F = 3.3, P < 0.05, η² = 0.70).

Conclusion:

The study concludes that the combined mandibular cortical findings (P < 0.05) and mandibular cortical shape erosion alone (P < 0.001) on panoramic radiograph are effective indicators of osteoporosis in post-menopausal women.

Osteoporosis, fragility fracture, and periodontal disease: a cross-sectional study in Spanish postmenopausal women

OBJECTIVE

Osteoporosis and periodontitis are common disorders that affect aging populations. It has been hypothesized that both conditions may be related. The aim of this study was to evaluate the relationship between osteoporosis and periodontitis using vertebral fragility fracture as a real marker of osteoporosis and periodontal clinical examination to define periodontitis.

METHODS

Six hundred thirty-four women aged 55 to 70 years, with fragility spine fractures, and living in the same healthcare region of Seville, Spain, were invited to take part in this cross-sectional study conducted from 2008 to 2010. All the women included in the study were referred to undergo spine radiological examination, spinal densitometry, and full-mouth periodontal assessment.

RESULTS

With the exception of number of teeth (19 in the fractured postmenopausal group and 23 in the control group; P < 0.007) and sites with a clinical attachment level lower than 7 mm (P < 0.048), there were no significant differences in clinical and periodontal parameters among women in the fractured postmenopausal group and the control group. In short, fractured postmenopausal women have lost more teeth with more advanced attachment loss (clinical attachment level >7 mm). None of the definitions of periodontitis used resulted in significant differences between groups.

CONCLUSIONS

The relationship between periodontitis and osteoporosis remains unclear, and further studies considering fragility fracture as a real marker of osteoporosis are warranted to clarify the exact role and effect of one condition on the other and the corresponding clinical implications.

Assessment of alveolar bone mineral density as a predictor of lumbar fracture probability

INTRODUCTION

Osteoporosis and tooth loss have been linked with advancing age, but no clear relationship between these conditions has been proven. Several studies of bone mineral density measurements of the jaw and spine have shown similarities in their rate of age-related deterioration. Thus, measurements of jawbone density may predict lumbar vertebral bone density. Using jawbone density as a proxy marker would circumvent the need for lumbar bone measurements and facilitate prediction of osteoporotic spinal fracture susceptibility at dental clinics. We aimed to characterize the correlation between bone density in the jaw and spine and the incidence of osteoporotic spinal fractures.

METHODS

We used computerized radiogrammetry to measure alveolar bone mineral density (al-BMD) and dual-energy X-ray absorptiometry to measure lumbar bone mineral density (L-BMD). L-BMD and al-BMD in 30 female patients (average age: 59 ± 5 years) were correlated with various patient attributes. Statistical analysis included area under the curve (AUC) and probability of asymptomatic significance (PAS) in a receiver operating characteristic curve. The predictive strength of L-BMD T-scores (L-BMD[T]) and al-BMD measurements for fracture occurrence was then compared using multivariate analysis with category weight scoring.

RESULTS

L-BMD and al-BMD were significantly correlated with age, years since menopause, and alveolar bone thickness. Both were also negatively correlated with fracture incidence. Category weight scores were -0.275 for a L-BMD(T) <80%; +0.183 for a L-BMD(T) ≥ 80%; -0.860 for al-BMD <84.9 (brightness); and +0.860 for al-BMD ≥ 84.9. AUC and PAS analyses suggested that al-BMD had a higher association with fracture occurrence than L-BMD.

CONCLUSIONS

Our results suggest the possible association between al-BMD and vertebral fracture risk. Assessment of alveolar bone density may be useful in patients receiving routine dental exams to monitor the clinical picture and the potential course of osteoporosis in patients who may be at a higher risk of developing osteoporosis.

The relationship between the calcaneal bone mineral density and the mental index in post-menopausal females

OBJECTIVES

The aim of the study was to determine the relationship between the bone mineral density in the calcaneus and the mental index (MI) of the mandible in post-menopausal females, and to evaluate the diagnostic threshold of the index.

METHODS

The post-menopausal females aged 50 years and older were examined using panoramic radiography of the mandible for mandibular cortical width measurements at the mental foramen (mental index, MI) determination and DXL Calscan P/N 031000 (Demetech AB, Solna, Sweden) for the examination of calcaneal bone mineral density (BMD). The statistical analysis was performed to determine the tendencies between the data.

RESULTS

According to the T-score values of calcaneal BMD, the subjects were distributed into T1, T2 and T3 groups. BMD differences between the groups were statistically significant (p < 0.001). The panoramic radiographic examination of the mandible was performed, MI (mm) was determined and the mean values in the groups were calculated. The differences of MI mean values between the groups were statistically significant (p < 0.001). In the general group, a statistically significant relationship was found between calcaneal BMD, T-score and MI (p < 0.001). In the logistic analysis, the diagnostic threshold of MI was 3 mm (sensitivity 73.5%; specificity 72.6%).

CONCLUSIONS

A diagnostic threshold for MI of 3 mm or less is suggested as the appropriate threshold for referral of calcaneal BMD reduction.

Relationship between bone mineral density and trabecular bone pattern in postmenopausal osteoporotic Brazilian women

OBJECTIVES

The aim of this study is to evaluate the relative efficacy of the mandibular trabecular bone in detecting osteoporotic-associated bone changes in Brazilian women.

MATERIALS AND METHODS

Seventy-three digital panoramic radiographs of healthy and osteoporotic postmenopausal women were used. Regions of interest were selected in the mandibular angle and body of the panoramic images, which were analyzed for fractal dimension (FD) and pixel intensity (PI). Statistical analysis evaluated the distribution pattern, compared normal with osteoporotic patients and the right with the left mandible, and assessed the relationship between FD and PI. The significance level was set at 0.05.

RESULTS

FD and PI values were significantly different (p < 0.05) between normal and osteoporotic patients for the right and left mandibular angle and for the left mandibular body. There was no significant difference (p > 0.05) between the right and left mandibular angle for FD and PI, but a significant difference (p < 0.05) was observed on the mandibular body for PI values. FD and PI values presented positive correlation.

CONCLUSIONS

The mandibular trabecular bone was effective in detecting osteoporotic changes, with the exception of the right mandibular body.

CLINICAL RELEVANCE

Mandibular trabecular bone shows a promising attempt of accurate detection of osteoporotic changes in some regions of the jaws. Fractal analysis and pixel intensity had strong positive correlation.

Computer-aided system for morphometric mandibular index computation. (Using dental panoramic radiographs)

OBJECTIVE

We propose and validate a computer-aided system to measure three different mandibular indexes: cortical width, panoramic mandibular index and, mandibular alveolar bone resorption index.

STUDY DESIGN

Repeatability and reproducibility of the measurements are analyzed and compared to the manual estimation of the same indexes.

RESULTS

The proposed computerized system exhibits superior repeatability and reproducibility rates compared to standard manual methods. Moreover, the time required to perform the measurements using the proposed method is negligible compared to perform the measurements manually.

CONCLUSIONS

We have proposed a very user friendly computerized method to measure three different morphometric mandibular indexes. From the results we can conclude that the system provides a practical manner to perform these measurements. It does not require an expert examiner and does not take more than 16 seconds per analysis. Thus, it may be suitable to diagnose osteoporosis using dental panoramic radiographs.

Description of mandibular bone quality based on measurements of cortical thickness using Mental Index of male and female patients between 40-60 years old

Purpose

The purpose of this study was to obtain the description of the mandibular bone quality of male and female patients between 40-60 years old and their differences based on mandibular cortical bone thickness measured using Mental Index (MI).

Materials and Methods

Forty digital panoramic radiographs, which consisted of twenty male and twenty female patients, 40-60 years old, were observed. Mandibular cortical bone thickness was measured using MI on both sides of the mandible. The average MI score of two groups were then assessed using t-sample independent test.

Results

There were significant differences of mandibular bone quality based on mandibular cortical bone thickness measurement using MI between male and female patients (p<0.05).

Conclusion

Mandibular bone quality based on cortical bone thickness measurement using MI of male and female patients indicated a significant difference.

Detecting young Japanese adults with undetected low skeletal bone density using panoramic radiographs

OBJECTIVE

The cortical width below the mental foramen of the mandible determined from panoramic radiographs is a useful screening tool for identifying elderly individuals with a low skeletal bone mineral density (BMD). However, whether the mandible cortical width (MCW) is useful for identifying a low skeletal BMD in men and women of 40 years or younger is not known.

METHODS

The BMD of the calcaneus was measured by ultrasonography bone densitometry in 158 men and 76 women aged 18-36 years. A logistic regression analysis adjusted for age was used to calculate the odds ratios and 95% confidence interval (CI) of having a low calcaneal BMD, according to the quartiles of the MCW. The areas under the receiver operator characteristic curve (AUC) for identifying participants with a low calcaneal BMD using the MCW were assessed to evaluate the diagnostic efficacy of the MCW.

RESULTS

In men, the adjusted odds ratios of a low calcaneal BMD associated with the second, third and lowest quartiles of MCW were 5.66 (95% CI, 0.61-52.23), 5.43 (95% CI, 0.59-50.18) and 33.22 (95% CI, 3.97-276.94), respectively, compared with the highest quartile, while no significant trend in the adjusted odds ratios was observed in women. The AUC for identifying participants with a low calcaneal BMD based on the MCW was 0.796 (95% CI, 0.702-0.890) in men and 0.593 (95% CI, 0.398-0.788) in women.

CONCLUSION

MCW determined from panoramic radiographs can be used to identify undetected low calcaneus BMD in young adult men, but not in young adult women.

Evaluation of Correlation between Width and Morphology of Mandibular Inferior Cortex in Digital Panoramic Radiography and Postmenopausal Osteoporosis

BACKGROUND

In osteoporotic patients, inferior mandibular cortex undergoes resorption which its manifestations can be detected on dental panoramic radiographs as a simple and available method. The aim of this study was to evaluate the correlation between width and morphology of mandibular inferior cortex in digital panoramic radiography and postmenopausal osteoporosis.

METHODS

Bone mineral density (BMD) of lumbar vertebrae and femural neck of 119 postmenopause women was assessed using DXA. Width [cortical index (CI)] and morphology [mandibular cortical index (MCI)] of inferior mandibular cortex were measured and the correlations between BMD and width and shape of the inferior mandibular cortex were evaluated.

RESULTS

The specificity and sensitivity in identifying women with low BMD of lumbar vertebrae by visual cortical estimation (normal or eroded) were 69.4% and 80.7% respectively. These results in identifying women with low BMD of femural neck were 67.7% and 81.5% respectively. For both sides, the threshold value that provided the highest validity (minimal false negative and false positive results) corresponded to cortical width of 4.29 mm. This threshold in lumbar vertebrae or femural neck provided a sensitivity of 81.4% (95% CI=69.1%-90.3%), specificity of 58.3% (95% CI=44.9%-70.9%), positive predictive value of 65.8% and likelihood ratio of 1.95. There were significant associations between BMD and CI and MCI.

CONCLUSION

Postmenopausal women with thin or eroded mandibular inferior cortex may have an increased risk for low BMD or osteoporosis.

Triage screening for osteoporosis in dental clinics using panoramic radiographs

Many patients with osteoporosis go undiagnosed because typically no symptoms are present before a fracture. Triage screening to refer patients to appropriate medical professionals for further investigation would be useful to address the increase in the incidence of osteoporotic fractures. Dental clinics may offer a new triage screening pathway because dentists frequently take radiographs of bones in the course of dental treatment. A major premise for such triage screening in dental clinics is that dentists can readily use a screening tool in their dental practice. For example, cortical width and shape of the mandible detected on panoramic radiographs may be appropriate indices for triaging individuals with osteoporosis. To date, several investigators have demonstrated significant associations between cortical indices on panoramic radiographs and bone mineral density of the skeleton generally, such as the spine and femur, biochemical markers of bone turnover and risk of osteoporotic fractures. Further, in two recent Japanese clinical trials, approximately 95% of women who were identified by trained dentists in their clinics using cortical shape findings did have osteopenia or osteoporosis. These findings support the possibility that dental clinics may offer a new triage platform to identify individuals with otherwise undetected osteoporosis.

Osteoporosis and its implications for dental patients

BACKGROUND

Osteoporosis is a common disease in middle-aged and older Americans. The risk of sustaining fractures is a concern, and mortality rates after hip or vertebral fractures are high. Oral health maintenance for adults with osteoporosis is important.

TYPES OF STUDIES REVIEWED

The authors conducted a MEDLINE search of the medical and dental literature with the objective of reviewing osteoporosis, its effect on public health in the population in the United States and the implications in providing dental care for these patients. They selected studies by performing a content search with National Library of Medicine medical subject headings (epidemiology, public health impact, treatment, adverse drug reactions, cost-effectiveness of osteoporosis therapy, oral health, periodontal disease, adverse drug reactions, bisphosphonates and osteonecrosis of the jaw). They then performed a study design search with a filter so that only randomized clinical trials were included.

RESULTS

Osteoporosis and related fractures are more common than coronary disease, stroke and breast cancer. Fractures resulting from osteoporosis can affect a patient's quality of life severely, and fractures result in functional impairment and increased health care cost and mortality. Medical management of osteoporosis includes diet control, with appropriate intake of calcium and vitamin D, weight-bearing exercise, discontinuation of tobacco and alcohol intake, and use of medications, including selective estrogen receptor modulators, calcitonin, anabolic agents and bisphosphonates. Bisphosphonates have been associated with the development of osteonecrosis of the jaws.

CLINICAL IMPLICATIONS

Oral health maintenance is important in patients with osteoporosis. Bisphosphonate therapy or other medical treatment for these people should be discontinued only after consultation with the patient's physician.

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.