Journal of Craniomaxillofacial Research 2017. 4(2):345-351.

Diagnosis of osteoporosis using cortex mandibular indices based on cortex thickness and morphology in comparison with visual assessment of the cortex
Maryam Tofangchiha, Mansour Khorasani, Maryam Shokrimozhdehi, Amir Javadi

Abstract


Introduction: Osteoporosis is a common condition causing significant morbidity and mortality. There is some evidence of a correlation between bone mineral density of the mandible and that of the lumbar spine and hip. The ability to accurately detect osteoporosis based on routine dental
imaging would allow early diagnosis. The aim of this study was to compare the diagnostic accuracy for low bone mineral density using mandibular radio morphometric indices versus simple visual inspection of the mandibular cortex.
Materials and Methods: Four independent investigators evaluated radio morphometric indices (mental index, antigonial index and morphology of the cortex) as well as assigning a rating
of thin or normal cortex based on their initial impression on the panoramic radiographs of 49 post menopausal women with decreased bone mineral density and 42 unaffected controls. The sensitivity, specificity and positive predictive value for each index was evaluated.
Results: The mental and antegonial index had better sensitivity than specificity and positive predictive value. However the opposite was true for the morphology index and simple visual inspection of cortical thickness. External agreement was moderate to perfect (0.41 -0.93) for cortex morphology, and moderate to substantial (0.49-0.76) for simple visual inspection of cortical thickness but excellent for mandibular and antegonial index (> 0.8).
Conclusion: We found that the mandibular cortical thickness is affected in postmenopausal women with low bone mineral density when compared to controls. Furthermore radio morphometric
indices and morphology are more accurate in the diagnosis of osteoporosis than simple visual assessment of cortical thickness.
Key words: Cortex, Mandible, Osteoporosis, Radiography.

Keywords


Cortex; Mandible; Osteoporosis; Radiography.

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References


Prevention and management of osteoporosis. World Health Organ Tech Rep Ser 2003; 921:1-164, back cover.

Kanis JA, Johnell O, Oden A, Sembo I, Red- lund-Johnell I, Dawson A, et al. Long-term risk of osteoporotic fracture in Malmö. Osteoporos Int.2000; 11(8):669-74.

Kanis JA, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A. Prediction of fracture from low bone mineral density measurements overestimates risk. Bone. 2000; 26(4):387-91.

Kanis JA, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A. Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone. 2000; 27(5):585-90.

Melton LJ 3rd, Atkinson EJ, O’Connor MK, O’Fal- lon WM, Riggs BL. Bone density and fracture risk in men. J Bone Miner Res. 1998;13(12):1915-23.

Melton LJ 3rd, Chrischilles EA, Cooper C, Lane AW, Riggs BL. Perspective. How many wom- en have osteoporosis? J Bone Miner Res. 1992;7(9):1005-10.

Kaleta M, Wroński S. The most common errors in the densitometric diagnosis of osteoporosis. Or- top Traumatol Rehabil. 2001; 3(3):338-44.

Cummings SR, Bates D, Black DM. Clinical use of bone densitometry: scientific review. JAMA.2002;288(15):1889-97.

Klemetti E, Kolmakov S, Kröger H. Pantomogra- phy in assessment of the osteoporosis risk group. Scand J Dent Res. 1994; 102(1):68-72.

López-López J, Estrugo-Devesa A, Jane-Salas E, Ayuso-Montero R, Gómez-Vaquero C. Early diag- nosis of osteoporosis by means of orthopantomo- grams and oral x-rays: a systematic review. Med Oral Patol Oral Cir Bucal. 2011; 16(7):e905-913.

Sedrine WB, Chevallier T, Zegels B, Kvasz A, Micheletti MC, Gelas B, et al. Development and assessment of the Osteoporosis Index of Risk (OSIRIS) to facilitate selection of wom- en for bone densitometry. Gynecol Eendocrinol.2002;16(3):245-50.

Ledgerton D, Horner K, Devlin H, Worthington H. Radiomorphometric indices of the mandible in a British female population. Dentomaxillofac Ra- diol. 1999; 28(3):173-81.

Landis JR, Koch GG. The measurement of ob- server agreement for categorical data. Biometrics.1977;33(1):159-74.

Taguchi A, Sanada M, Krall E, Nakamoto T, Oht- suka M, Suei Y, et al. Relationship between dental panoramic radiographic findings and biochemi- cal markers of bone turnover. J Bone Miner Res.2003; 18(9):1689-94.

Klemetti E, Kolmakow S. Morphology of the man- dibular cortex on panoramic radiographs as an in- dicator of bone quality. Dentomaxillofac Radiol.1997; 26(1):22-5.

Hüpsch-Marzec H, Ilewicz L, Klima D, Swieto- chowska E, Pluskiewicz W, Mykietów B. Assess- ment of selected parameters measured on pan- oramic radiographs in postmenopausal women. Przegl Lek. 2005; 62(12):1387-9.

Lee K, Taguchi A, Ishii K, Suei Y, Fujita M, Naka- moto T, et al. Visual assessment of the mandibular cortex on panoramic radiographs to identify post- menopausal women with low bone mineral densi- ties. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 100(2):226-31.

Yaşar F, Akgünlü F. The differences in panoram- ic mandibular indices and fractal dimension be- tween patients with and without spinal osteoporo- sis. Dentomaxillofac Radiol. 2006;35(1):1-9.

Gulsahi A, Paksoy CS, Ozden S, Kucuk NO, Cebe- ci AR, Genc Y. Assessment of bone mineral den- sity in the jaws and its relationship to radiomor- phometric indices. Dentomaxillofac Radiol. 2010;39(5):284-9.

Taguchi A, Suei Y, Sanada M, Ohtsuka M, Na- kamoto T, Sumida H, et al. Validation of dental panoramic radiography measures for identifying postmenopausal women with spinal osteoporosis. AJR Am J Roentgenol. 2004; 183(6):1755-60.

Drozdzowska B, Pluskiewicz W, Tarnawska B.Panoramic-based mandibular indices in relation to mandibular bone mineral density and skeletal status assessed by dual energy X-ray absorptiom etry and quantitative ultrasound. Dentomaxillofac Radiol. 2002; 31(6):361-7.

Devlin H, Horner K. Mandibular radiomor- phometric indices in the diagnosis of reduced skeletal bone mineral density. Osteoporos Int2002;13(5):373-8.

Ishii K, Taguchi A, Nakamoto T, Ohtsuka M, Sutthiprapaporn P, Tsuda M, et al. Diagnostic efficacy of alveolar bone loss of the mandible for identi- fying postmenopausal women with femoral oste- oporosis. Dentomaxillofac Radiol. 2007;36:28-33.

White SC, Taguchi A, Kao D, Wu S, Service SK, Yoon D, et al. Clinical and panoramic predictors of femur bone mineral density. Osteoporos Int.2005; 16(3):339-46.

Dutra V, Devlin H, Susin C, Yang J, Horner K, Fer- nandes AR. Mandibular morphological changes in low bone mass edentulous females: evaluation of panoramic radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102:663-8.

Taguchi A, Suei Y, Ohtsuka M, Otani K, Tanimo- to K, Ohtaki M. Usefulness of panoramic radi- ography in the diagnosis of postmenopausal os- teoporosis in women. Width and morphology of inferior cortex of the mandible. Dentomaxillofac Radiol. 1996; 25:263-7.


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