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Heuchert J, Kozieł S, Spinek AE. Radiomorphometric indices of the mandible as indicators of decreased bone mineral density and osteoporosis - meta-analysis and systematic review. Osteoporos Int 2024; 35:401-412. [PMID: 37870561 PMCID: PMC10867062 DOI: 10.1007/s00198-023-06949-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
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.
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Affiliation(s)
- Joanna Heuchert
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Weigla 12, 53-114, Wrocław, Poland.
| | - Sławomir Kozieł
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Weigla 12, 53-114, Wrocław, Poland
| | - Anna E Spinek
- Department of Anthropology, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Weigla 12, 53-114, Wrocław, Poland
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Rupel K, Dal Broi C, Ottaviani G, Bellassai L, Bogdan Preda TM, Di Lenarda R, Biasotto M. Changes in mandibular radiomorphometric indices in osteoporosis patients treated with denosumab: a retrospective case-control study. BMC Oral Health 2024; 24:89. [PMID: 38229055 DOI: 10.1186/s12903-024-03870-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/06/2024] [Indexed: 01/18/2024] Open
Abstract
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.
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Affiliation(s)
- Katia Rupel
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, n 447 - 34129, Trieste, Italy.
| | - Chiara Dal Broi
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, n 447 - 34129, Trieste, Italy
| | - Giulia Ottaviani
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, n 447 - 34129, Trieste, Italy
| | - Laura Bellassai
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, n 447 - 34129, Trieste, Italy
| | | | - Roberto Di Lenarda
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, n 447 - 34129, Trieste, Italy
| | - Matteo Biasotto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, n 447 - 34129, Trieste, Italy
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Nasreen S, Ramesh DNSV, Thriveni R, Bayatnal A, Chowdhury RM, Kattimani S, Saba R. Assessment of alveolar bone mass using radio morphometric indices in urban and rural postmenopausal women and their correlation with serum vitamin D3 level. Indian J Dent Res 2019; 30:722-730. [PMID: 31854363 DOI: 10.4103/ijdr.ijdr_369_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Saba Nasreen
- Department of Oral Medicine and Radiology, Mithila Minority Dental College and Hospital, Samastipur Road, Mansukh Nagar (Ekmighat), Laheriasarai, Darbhanga, Bihar, India
| | | | - Rukmangada Thriveni
- Department of Oral Medicine and Radiology, AME's Dental College and Hospital, Bijanagera Road, Raichur, Karnataka, India
| | - Amit Bayatnal
- Department of Oral Medicine and Radiology, AME's Dental College and Hospital, Bijanagera Road, Raichur, Karnataka, India
| | - Ripon Md Chowdhury
- Department of Oral and Maxillofacial Pathology, Hi-Tech Dental College and Hospital, High Tech Hospital Road, Pandara, Rasulgarh, Bhubaneswar, Odisha, India
| | - Shweta Kattimani
- Department of Oral Medicine and Radiology, AME's Dental College and Hospital, Bijanagera Road, Raichur, Karnataka, India
| | - Raunaque Saba
- Department of Oral Medicine and Radiology, Radix Dental Care, 30/2 Fazlul Haque Sarani, Kolkata, West Bengal, India
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Kato CN, Tavares NP, Barra SG, Amaral TM, Brasileiro CB, Abreu LG, Mesquita RA. Digital panoramic radiography and cone-beam CT as ancillary tools to detect low bone mineral density in post-menopausal women. Dentomaxillofac Radiol 2018; 48:20180254. [PMID: 30306800 DOI: 10.1259/dmfr.20180254] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the usefulness of the mandibular cortical index (MCI) obtained by digital panoramic radiography (DPR) and by panoramic reconstruction (PR) of cone-beam CT (CBCT) with three different slice thicknesses for the screening of low bone mineral density (BMD) in post-menopausal women. METHODS Two trained oral and maxillofacial radiologists assessed the MCI based on the morphology of the mandibular bone cortex (classified as C1, C2 or C3). The DPR and PR of CBCT with slice thicknesses of 5, 15 or 25 mm were compared to the BMD obtained by dual-energy X-ray absorptiometry (DXA) in post-menopausal women. Measures related to accuracy were calculated with MedCalc software. The confidence interval was set at 95%. RESULTS 54 women (mean age 58.70 ± 7.35 years) participated in the study. The sensitivity and specificity values obtained for DPR were 52.6% and 56.2%, respectively, and values for PR of CBCT with 5, 15, and 25 mm slice thicknesses were 63.1% and 43.7%, 50.0% and 50.0%, and 52.6% and 62.5%, respectively. For the tools evaluated, the positive likelihood ratio ranged from 1.00 to 1.40 and negative likelihood ratio from 0.76 to 1.00. The positive predictive value (PPV) ranged from 70.4 to 76.9% and the negative predictive value (NPV) from 29.6 to 35.7%. Among the examinations, the highest value for area under the curve (AUC) was obtained for CBCT with 25 mm slice thickness (57.6%). CONCLUSIONS The MCI calculated by DPR and CBCT differed with regard to accuracy. Within the limitations of this study, the PR of CBCT with 25 mm slice thicknesses seems to be the most accurate among the examinations evaluated. Should the dentist be attentive, DPR and CBCT may be useful tools for the screening of low BMD in post-menopausal women, facilitating their timely referral for further assessment.
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Affiliation(s)
- Camila Nao Kato
- 1 Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Núbia Pk Tavares
- 1 Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Sâmila G Barra
- 1 Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Tânia Mp Amaral
- 1 Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Cláudia B Brasileiro
- 1 Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Lucas G Abreu
- 2 Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - Ricardo A Mesquita
- 1 Department of Oral Pathology and Surgery, School of Dentistry, Federal University of Minas Gerais , Belo Horizonte , Brazil
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Barngkgei I, Halboub E, Almashraqi AA, Khattab R, Al Haffar I. IDIOS: An innovative index for evaluating dental imaging-based osteoporosis screening indices. Imaging Sci Dent 2016; 46:185-202. [PMID: 27672615 PMCID: PMC5035724 DOI: 10.5624/isd.2016.46.3.185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 10/13/2015] [Accepted: 12/11/2015] [Indexed: 01/10/2023] Open
Abstract
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.
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Affiliation(s)
- Imad Barngkgei
- Department of Oral Medicine, Faculty of Dentistry, Damascus University, Damascus, Syria.; Department of Oral Medicine, Faculty of Dentistry, Syrian Private University, Damascus, Syria
| | - Esam Halboub
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Abeer Abdulkareem Almashraqi
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia.; Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ibb University, Ibb, Yemen
| | - Razan Khattab
- Department of Periodontology, Faculty of Dentistry, Damascus University, Damascus, Syria
| | - Iyad Al Haffar
- Department of Oral Medicine, Faculty of Dentistry, Damascus University, Damascus, Syria
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Factors affecting observer agreement in morphological evaluation of mandibular cortical bone on panoramic radiographs. Oral Radiol 2016. [DOI: 10.1007/s11282-016-0253-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Association of cortical shape of the mandible on panoramic radiographs with mandibular trabecular bone structure in Japanese adults: a cone-beam CT-image analysis. Oral Radiol 2013. [DOI: 10.1007/s11282-013-0155-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rabiei M, Masooleh IS, Leyli EK, Nikoukar LR. Salivary calcium concentration as a screening tool for postmenopausal osteoporosis. Int J Rheum Dis 2012; 16:198-202. [PMID: 23773645 DOI: 10.1111/1756-185x.12003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Measurements of salivary calcium level may be a useful screening tool for osteoporosis in postmenopausal women. The purpose of this study was to clarify whether this measure is valid compared with dual-energy X-ray (Bone Mineral Density) screening tools in osteoporosis. METHODS A case-control study was carried out in 40 postmenopausal women with osteoporosis (T-score ≤ -2.5) and 40 women without osteoporosis (T-score > -1 bone mineral density). Salivary samples were collected and calcium concentrations were measured and expressed as mg/dL. Receiver operating characteristic curve analyses was used to determine the optimal cut-off thresholds for salivary calcium in healthy postmenopausal women. RESULTS The cut-off point for salivary calcium was 6.1 mg/dL. The sensitivity and specificity, respectively, for identifying women with osteoporosis, were 67.5 (95%CI 52.33-82.67) and 60% (95%CI 44.62-75.38). The area under curve (AUC) was 0.678 (95%CI 0.56-0.79), the positive predictive value (PPV) was 62.79 (95%CI 47.74-77.84) and negative predictive value (NPV) was 64.86% (95%CI 49.27-80.46). The positive likelihood ratio was 1.688 and the negative likelihood ratio was 0.542. CONCLUSIONS Salivary calcium concentration discriminates between women with and without osteoporosis and constitutes a useful tool for screening for osteoporosis.
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Affiliation(s)
- Maryam Rabiei
- Department of Oral Medicine, Dental School, Guilan University of Medical Sciences, Rasht, Iran.
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Leite AF, de Souza Figueiredo PT, Ramos Barra F, Santos de Melo N, de Paula AP. Relationships between mandibular cortical indexes, bone mineral density, and osteoporotic fractures in Brazilian men over 60 years old. ACTA ACUST UNITED AC 2011; 112:648-56. [DOI: 10.1016/j.tripleo.2011.06.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 06/10/2011] [Accepted: 06/16/2011] [Indexed: 10/17/2022]
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Evaluation of Correlation between Width and Morphology of Mandibular Inferior Cortex in Digital Panoramic Radiography and Postmenopausal Osteoporosis. IRANIAN RED CRESCENT MEDICAL JOURNAL 2011; 13:181-6. [PMID: 22737460 PMCID: PMC3371939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 07/21/2010] [Accepted: 08/02/2010] [Indexed: 10/27/2022]
Abstract
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.
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Dvorak G, Reich KM, Tangl S, Goldhahn J, Haas R, Gruber R. Cortical porosity of the mandible in an osteoporotic sheep model. Clin Oral Implants Res 2010; 22:500-5. [DOI: 10.1111/j.1600-0501.2010.02031.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Panoramic radiographs for identifying individuals with undetected osteoporosis. JAPANESE DENTAL SCIENCE REVIEW 2009. [DOI: 10.1016/j.jdsr.2009.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
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.
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Affiliation(s)
- A Taguchi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Matsumoto Dental University, Hirooka, Shiojiri, Japan.
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