Radiomorphometric Indices of the Mandible as a Screening Tool for Osteoporosis
-
Mansour Khorasani
,
Homayon Sheikholeslami
,
Samaneh Rastegari
,
Amir Javadi
,
Taniya Poorsoleiman
,
Maryam Tofangchiha
Abstract
Introduction: Osteoporosis is the most common metabolic bone disease and is characterized by an increased risk of bone fractures. Early detection of osteoporosis is necessary to prevent hip fractures later in life. We evaluated changes in mandibular radiomorphometric indices in postmenopausal women using Dual Energy X-Ray Absorptiometry (DXA) to assess their association with Osteoporosis. Materials and Methods: Nine radiomorphometric indices and the number of mandibular teeth on dental panoramic radiographs were evaluated in 85 post-menopausal women at age 45-74. DXA measured bone mineral density (BMD) at the lumbar spine. BMD values were categorized as normal (T-score greater than -1.0), indicative of osteopenia (-1.0 T-score<-2.5), or osteoporosis (T-score<-2.5) according to the World Health Organization classification. Results: The AA, AI and MI were significantly smaller in individuals with low bone mass (p<0.05). The AD was significantly larger in osteoporotic individuals (p<0.05) and the comparison of MCI among the three subgroups of MBD showed significant differences. There was no significant difference between the three categories of skeletal bone status for PMI, M/M Ratio, GA and the number of mandibular teeth. Conclusion: Osteoporotic individuals are more likely to have altered inferior cortex and antegonial region morphology and thickness than non-osteoporotic individuals. The smaller AI and larger AD were strongly associated with lower bone mass. Clinical relevance: In this study, we provided a model to assess the risk of osteopenia or osteoporosis in dental panoramic radiography. Keywords: Osteoporosis; Panoramic radiography; Mandible; Bone mineral density.
1. López López J, Estrugo Devesa A, Jané Salas E, Ayuso Montero R, Gómez Vaquero C. Early diagnosis of osteoporosis by means of orthopantomograms and oral x-rays: a systematic review. 2011.
2. Nolla J, Gómez-Vaquero C, Fiter J, Vilaseca DR, Mateo L, Rozadilla A, et al. Usefulness of bone densitometry in postmenopausal women with clinically diagnosed vertebral fractures. Annals of the rheumatic diseases. 2002;61(1):73-5.
3. Wong CP, Gani LU. Dual-energy X-ray absorptiometry bone densitometry and pitfalls in the assessment of osteoporosis: a primer for the practicing clinician. Archives of Osteoporosis. 2020;15(1):1-11.
4. Kanis J, Johnell O. Requirements for DXA for the management of osteoporosis in Europe. Osteoporosis international. 2005;16(3):229-38.
5. Taguchi A, Ohtsuka M, Tsuda M, Nakamoto T, Kodama I, Inagaki K, et al. Risk of vertebral osteoporosis in post-menopausal women with alterations of the mandible. Dentomaxillofacial Radiology. 2007;36(3):143-8.
6. Groen J, Duyvensz F, Halsted J. Diffuse alveolar atrophy of the jaw (non-inflammatory form of paradental disease) and pre-senile osteoporosis. Gerontologia clinica. 1960;2(2):68-86.
7. Horner K, Devlin H. The relationship between mandibular bone mineral density and panoramic radiographic measurements. Journal of dentistry. 1998;26(4):337-43.
8. Cakur B, Dagistan S, Sahin A, Harorli A, Yilmaz A. Reliability of mandibular cortical index and mandibular bone mineral density in the detection of osteoporotic women. Dentomaxillofacial Radiology. 2009;38(5):255-61.
9. Vlasiadis KZ, Skouteris CA, Velegrakis GA, Fragouli I, Neratzoulakis JM, Damilakis J, et al. Mandibular radiomorphometric measurements as indicators of possible osteoporosis in postmenopausal women. Maturitas. 2007;58(3):226-35.
10. Guiglia R, Di-Fede O, Lo-Russo L, Sprini D, Rini GB, Campisi G. Osteoporosis, jawbones and periodontal disease. Medicina oral, patología oral y cirugía bucal. 2013;18(1):e93.
11. Organization WH. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Geneva: Report of a WHO Study Group. 1994.
12. Dutra V, Yang J, Devlin H, Susin C. Mandibular bone remodelling in adults: evaluation of panoramic radiographs. Dentomaxillofacial Radiology. 2004;33(5):323-8.
13. Dutra V, Devlin H, Susin C, Yang J, Horner K, Fernandes ARC. Mandibular morphological changes in low bone mass edentulous females: evaluation of panoramic radiographs. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2006;102(5):663-8.
14. Dutra V, Yang J, Devlin H, Susin C. Radiomorphometric indices and their relation to gender, age, and dental status. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2005;99(4):479-84.
15. Devlin C, Horner K, Devlin H. Variability in measurement of radiomorphometric indices by general dental practitioners. Dentomaxillofacial Radiology. 2001;30(2):120-5.
16. Yasar F, Akgunlu F. The differences in panoramic mandibular indices and fractal dimension between patients with and without spinal osteoporosis. Dentomaxillofacial radiology. 2006;35(1):1-9.
17. Jowitt N, MacFarlane T, Devlin H, Klemetti E, Horner K. The reproducibility of the mandibular cortical index. Dentomaxillofacial Radiology. 1999;28(3):141-4.
18. Taguchi A, Tanimoto K, Suei Y, Ohama K, Wada T. Relationship between the mandibular and lumbar vertebral bone mineral density at different postmenopausal stages. Dentomaxillofacial Radiology. 1996;25(3):130-5.
19. Hill K. The demography of menopause. Maturitas. 1996;23(2):113-27.
20. Espallargues M, Sampietro-Colom L, Estrada M, Sola M, Del Rio L, Setoain J, et al. Identifying bone-mass-related risk factors for fracture to guide bone densitometry measurements: a systematic review of the literature. Osteoporosis International. 2001;12(10):811-22.
21. Devlin H, Horner K. Mandibular radiomorphometric indices in the diagnosis of reduced skeletal bone mineral density. Osteoporosis international. 2002;13(5):373-8.
22. Gomes C, de Rezende Barbosa G, Bello R, Bóscolo F, De Almeida S. A comparison of the mandibular index on panoramic and cross-sectional images from CBCT exams from osteoporosis risk group. Osteoporosis International. 2014;25(7):1885-90.
23. Kingsmill V, Boyde A. Variation in the apparent density of human mandibular bone with age and dental status. The Journal of Anatomy. 1998;192(2):233-44.
24. Bollen A-M, Taguchi A, Hujoel PP, Hollender LG. Case-control study on self-reported osteoporotic fractures and mandibular cortical bone. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2000;90(4):518-24.
25. Tafakhori Z, Nejati H. Panoramic Radiomorphometric Indices of the Mandible in an Iranian Population. 2016.
26. Dalili Z, MOGHADAM QA. AN INVESTIGATION ON MANDIBULAR INDICES IN NORMAL FEMALE POPULATION REFERRED TO MAXILLOFACIAL RADIOLOGY CENTERS IN RASHT. 2003.
27. Maki K, Miller A, Okano T, Shibasaki Y. Changes in cortical bone mineralization in the developing mandible: a three‐dimensional quantitative computed tomography study. Journal of Bone and Mineral Research. 2000;15(4):700-9.
28. Ledgerton D, Horner K, Devlin H, Worthington H. Panoramic mandibular index as a radiomorphometric tool: an assessment of precision. Dentomaxillofacial radiology. 1997;26(2):95-100.
29. Nemati S, Kajan ZD, Saberi BV, Arzin Z, Erfani MH. Diagnostic value of panoramic indices to predict osteoporosis and osteopenia in postmenopausal women. Journal of Oral and Maxillofacial Radiology. 2016;4(2):23.
30. M Johari K, H Jabbari K. Relationship among panoramic radiogaphy findings, biochemical markers of bone turnover and hip BMD in the diagnosis of postmenopausal osteoporosis. 2011.
31. Taguchi A, Suei Y, Ohtsuka M, Otani K, Tanimoto K, Ohtaki M. Usefulness of panoramic radiography in the diagnosis of postmenopausal osteoporosis in women. Width and morphology of inferior cortex of the mandible. Dentomaxillofacial Radiology. 1996;25(5):263-7.
32. Valerio CS, Trindade A, Mazzieiro ÊT, Amaral TP, Manzi FR. Use of digital panoramic radiography as an auxiliary means of low bone mineral density detection in post-menopausal women. Dentomaxillofacial Radiology. 2013;42(10):20120059.
33. Munhoz L, Aoki EM, Cortes AR, de Freitas CF, Arita ES. Osteoporotic alterations in a group of different ethnicity Brazilian postmenopausal women: An observational study. Gerodontology. 2018;35(2):101-9.
34. Dagistan S, Bilge O. Comparison of antegonial index, mental index, panoramic mandibular index and mandibular cortical index values in the panoramic radiographs of normal males and male patients with osteoporosis. Dentomaxillofacial Radiology. 2010;39(5):290-4.
35. Amorim M, Takayama L, Jorgetti V, Pereira R. Comparative study of axial and femoral bone mineral density and parameters of mandibular bone quality in patients receiving dental implants. Osteoporosis international. 2006;17(10):1494-500.
36. 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 absorptiometry and quantitative ultrasound. Dentomaxillofacial Radiology. 2002;31(6):361-7.
2. Nolla J, Gómez-Vaquero C, Fiter J, Vilaseca DR, Mateo L, Rozadilla A, et al. Usefulness of bone densitometry in postmenopausal women with clinically diagnosed vertebral fractures. Annals of the rheumatic diseases. 2002;61(1):73-5.
3. Wong CP, Gani LU. Dual-energy X-ray absorptiometry bone densitometry and pitfalls in the assessment of osteoporosis: a primer for the practicing clinician. Archives of Osteoporosis. 2020;15(1):1-11.
4. Kanis J, Johnell O. Requirements for DXA for the management of osteoporosis in Europe. Osteoporosis international. 2005;16(3):229-38.
5. Taguchi A, Ohtsuka M, Tsuda M, Nakamoto T, Kodama I, Inagaki K, et al. Risk of vertebral osteoporosis in post-menopausal women with alterations of the mandible. Dentomaxillofacial Radiology. 2007;36(3):143-8.
6. Groen J, Duyvensz F, Halsted J. Diffuse alveolar atrophy of the jaw (non-inflammatory form of paradental disease) and pre-senile osteoporosis. Gerontologia clinica. 1960;2(2):68-86.
7. Horner K, Devlin H. The relationship between mandibular bone mineral density and panoramic radiographic measurements. Journal of dentistry. 1998;26(4):337-43.
8. Cakur B, Dagistan S, Sahin A, Harorli A, Yilmaz A. Reliability of mandibular cortical index and mandibular bone mineral density in the detection of osteoporotic women. Dentomaxillofacial Radiology. 2009;38(5):255-61.
9. Vlasiadis KZ, Skouteris CA, Velegrakis GA, Fragouli I, Neratzoulakis JM, Damilakis J, et al. Mandibular radiomorphometric measurements as indicators of possible osteoporosis in postmenopausal women. Maturitas. 2007;58(3):226-35.
10. Guiglia R, Di-Fede O, Lo-Russo L, Sprini D, Rini GB, Campisi G. Osteoporosis, jawbones and periodontal disease. Medicina oral, patología oral y cirugía bucal. 2013;18(1):e93.
11. Organization WH. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Geneva: Report of a WHO Study Group. 1994.
12. Dutra V, Yang J, Devlin H, Susin C. Mandibular bone remodelling in adults: evaluation of panoramic radiographs. Dentomaxillofacial Radiology. 2004;33(5):323-8.
13. Dutra V, Devlin H, Susin C, Yang J, Horner K, Fernandes ARC. Mandibular morphological changes in low bone mass edentulous females: evaluation of panoramic radiographs. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2006;102(5):663-8.
14. Dutra V, Yang J, Devlin H, Susin C. Radiomorphometric indices and their relation to gender, age, and dental status. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2005;99(4):479-84.
15. Devlin C, Horner K, Devlin H. Variability in measurement of radiomorphometric indices by general dental practitioners. Dentomaxillofacial Radiology. 2001;30(2):120-5.
16. Yasar F, Akgunlu F. The differences in panoramic mandibular indices and fractal dimension between patients with and without spinal osteoporosis. Dentomaxillofacial radiology. 2006;35(1):1-9.
17. Jowitt N, MacFarlane T, Devlin H, Klemetti E, Horner K. The reproducibility of the mandibular cortical index. Dentomaxillofacial Radiology. 1999;28(3):141-4.
18. Taguchi A, Tanimoto K, Suei Y, Ohama K, Wada T. Relationship between the mandibular and lumbar vertebral bone mineral density at different postmenopausal stages. Dentomaxillofacial Radiology. 1996;25(3):130-5.
19. Hill K. The demography of menopause. Maturitas. 1996;23(2):113-27.
20. Espallargues M, Sampietro-Colom L, Estrada M, Sola M, Del Rio L, Setoain J, et al. Identifying bone-mass-related risk factors for fracture to guide bone densitometry measurements: a systematic review of the literature. Osteoporosis International. 2001;12(10):811-22.
21. Devlin H, Horner K. Mandibular radiomorphometric indices in the diagnosis of reduced skeletal bone mineral density. Osteoporosis international. 2002;13(5):373-8.
22. Gomes C, de Rezende Barbosa G, Bello R, Bóscolo F, De Almeida S. A comparison of the mandibular index on panoramic and cross-sectional images from CBCT exams from osteoporosis risk group. Osteoporosis International. 2014;25(7):1885-90.
23. Kingsmill V, Boyde A. Variation in the apparent density of human mandibular bone with age and dental status. The Journal of Anatomy. 1998;192(2):233-44.
24. Bollen A-M, Taguchi A, Hujoel PP, Hollender LG. Case-control study on self-reported osteoporotic fractures and mandibular cortical bone. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2000;90(4):518-24.
25. Tafakhori Z, Nejati H. Panoramic Radiomorphometric Indices of the Mandible in an Iranian Population. 2016.
26. Dalili Z, MOGHADAM QA. AN INVESTIGATION ON MANDIBULAR INDICES IN NORMAL FEMALE POPULATION REFERRED TO MAXILLOFACIAL RADIOLOGY CENTERS IN RASHT. 2003.
27. Maki K, Miller A, Okano T, Shibasaki Y. Changes in cortical bone mineralization in the developing mandible: a three‐dimensional quantitative computed tomography study. Journal of Bone and Mineral Research. 2000;15(4):700-9.
28. Ledgerton D, Horner K, Devlin H, Worthington H. Panoramic mandibular index as a radiomorphometric tool: an assessment of precision. Dentomaxillofacial radiology. 1997;26(2):95-100.
29. Nemati S, Kajan ZD, Saberi BV, Arzin Z, Erfani MH. Diagnostic value of panoramic indices to predict osteoporosis and osteopenia in postmenopausal women. Journal of Oral and Maxillofacial Radiology. 2016;4(2):23.
30. M Johari K, H Jabbari K. Relationship among panoramic radiogaphy findings, biochemical markers of bone turnover and hip BMD in the diagnosis of postmenopausal osteoporosis. 2011.
31. Taguchi A, Suei Y, Ohtsuka M, Otani K, Tanimoto K, Ohtaki M. Usefulness of panoramic radiography in the diagnosis of postmenopausal osteoporosis in women. Width and morphology of inferior cortex of the mandible. Dentomaxillofacial Radiology. 1996;25(5):263-7.
32. Valerio CS, Trindade A, Mazzieiro ÊT, Amaral TP, Manzi FR. Use of digital panoramic radiography as an auxiliary means of low bone mineral density detection in post-menopausal women. Dentomaxillofacial Radiology. 2013;42(10):20120059.
33. Munhoz L, Aoki EM, Cortes AR, de Freitas CF, Arita ES. Osteoporotic alterations in a group of different ethnicity Brazilian postmenopausal women: An observational study. Gerodontology. 2018;35(2):101-9.
34. Dagistan S, Bilge O. Comparison of antegonial index, mental index, panoramic mandibular index and mandibular cortical index values in the panoramic radiographs of normal males and male patients with osteoporosis. Dentomaxillofacial Radiology. 2010;39(5):290-4.
35. Amorim M, Takayama L, Jorgetti V, Pereira R. Comparative study of axial and femoral bone mineral density and parameters of mandibular bone quality in patients receiving dental implants. Osteoporosis international. 2006;17(10):1494-500.
36. 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 absorptiometry and quantitative ultrasound. Dentomaxillofacial Radiology. 2002;31(6):361-7.
| Files | ||
| Issue | Vol 12, No 2 (Spring 2025) | |
| Section | Original Article(s) | |
| Keywords | ||
| Osteoporosis Panoramic radiography Mandible Bone mineral density | ||
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How to Cite
1.
Khorasani M, Sheikholeslami H, Rastegari S, Javadi A, Poorsoleiman T, Tofangchiha M. Radiomorphometric Indices of the Mandible as a Screening Tool for Osteoporosis. J Craniomaxillofac Res. 2025;12(2):106-114.
