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      Digital panoramic radiography and CBCT as auxiliary tools for detection of low bone mineral density in post-menopausal women: a cross-sectional study

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          Abstract

          Background

          Osteoporosis is a chronic, multifactorial skeletal disease that occurs especially in women following a decrease in estrogen levels and decrease in bone mineral density. The aim of this study was to evaluate the relationship between qualitative and quantitative indexes in panoramic radiographs and quantitative indexes in CBCT images with femoral and vertebral BMD in postmenopausal women.

          Methods

          This comparative cross-sectional study was performed on postmenopausal women aging 40 to 80 years attending for obtaining either panoramic radiograph or mandibular CBCT scan. Dual energy X-ray absorptiometry (DEXA) was performed from the femur and lumbar vertebra. Quantitative parameters of mental index (MI), panoramic mandibular index (PMI), antegonial index (AI) as well as qualitative parameters of mandibular cortical index (MCI) and trabecular bone pattern (TP) were evaluated in panoramic radiographs. Quantitative parameters computed tomography mandibular index (CTMI), computed tomography index (inferior) [CTI(I)] and computed tomography index (superior) [CTI(S)] were analyzed in CBCT images. Kolmogorov-Smirnov tests and Pearson correlation coefficient were used (α = 0.05).

          Results

          In individuals with panoramic radiography, statistically significant correlations were observed between MI with vertebral and femoral T-score, AI with vertebral and femoral T-score (except for the right AI with femoral T-score), and TP with vertebral and femoral T-score (p < 0.05). In the group with CBCT scans, the correlations between CTMI with vertebral and femoral T-score, CTI(I) with vertebral and femoral T-score, and CTI(S) with vertebral and femoral T-score were statistically significant (p < 0.05).

          Conclusions

          in CBCT images, quantitative indexes of CTMI, CTI(I), and CTI(S), and in panoramic images, quantitative indexes of MI and AI and qualitative index of TP can be used to predict the possibility of osteoporosis in postmenopausal women.

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          Most cited references29

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          Clinical Practice. Postmenopausal Osteoporosis.

          Caren G. Solomon, Dennis M. Black, Clifford Rosen (2016)
          Key Clinical Points Postmenopausal Osteoporosis Fractures and osteoporosis are common, particularly among older women, and hip fractures can be devastating. Treatment is generally recommended in postmenopausal women who have a bone mineral density T score of -2.5 or less, a history of spine or hip fracture, or a Fracture Risk Assessment Tool (FRAX) score indicating increased fracture risk. Bisphosphonates (generic) and denosumab reduce the risk of hip, nonvertebral, and vertebral fractures; bisphosphonates are commonly used as first-line treatment in women who do not have contraindications. Teriparatide reduces the risk of nonvertebral and vertebral fractures. Osteonecrosis of the jaw and atypical femur fractures have been reported with treatment but are rare. The benefit-to-risk ratio for osteoporosis treatment is strongly positive for most women with osteoporosis. Because benefits are retained after discontinuation of alendronate or zoledronic acid, drug holidays after 5 years of alendronate therapy or 3 years of zoledronic acid therapy may be considered for patients at lower risk for fracture.
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            Panoramic measures for oral bone mass in detecting osteoporosis: a systematic review and meta-analysis.

            E. Calciolari, N Mardas, A Petrie … (2015)
            Different quantitative and qualitative indices calculated on oral panoramic radiographs have been proposed as useful tools to screen for reduced skeletal bone mineral density (BMD). Our aim was to systematically review the literature on linear and qualitative panoramic measures and to assess the accuracy of these indices by performing a meta-analysis of their sensitivity and specificity. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was followed. Fifty studies were included in the qualitative appraisal and 19 were considered for meta-analysis. The methodological quality of the retrieved studies, assessed with the QUADAS-2 tool, was on average low. Three indices were reported by most of the studies: mandibular cortical width, panoramic mandibular index, and the Klemetti index. Mandibular cortical width presented with a better accuracy in excluding osteopenia/osteoporosis (specificity), since patients with a cortical width more than 4 mm had a normal BMD in 90% of the cases. Almost all studies used a cutoff of 0.3 for the panoramic mandibular index, resulting in an estimated sensitivity and specificity in detecting reduced BMD, respectively, of 0.723 (SE 0.160; 95% confidence interval [CI], 0.352-0.926) and 0.733 (SE 0.066; 95% CI, 0.587-0.841). The presence of any kind of mandibular cortical erosion gave an estimated sensitivity and specificity in detecting reduced BMD, respectively, of 0.789 (SE 0.031; 95% CI, 0.721-0.843) and 0.562 (SE 0.047; 95% CI, 0.47-0.651) and a sensitivity and specificity in detecting osteoporosis, respectively, of 0.806 (SE 0.105; 95% CI, 0.528-0.9200) and 0.643 (SE 0.109; 95% CI, 0.417-0.820). The mandibular cortical width, panoramic mandibular index, and Klemetti index are overall useful tools that potentially could be used by dentists to screen for low BMD. Their limitations are mainly related to the experience/agreement between different operators and the different image quality and magnification of the panoramic radiographs.
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              Accuracy of linear measurements on CBCT images related to presurgical implant treatment planning: A systematic review

              George Fokas, Vida Vaughn, William Scarfe … (2018)
              Article 0 comments Cited 38 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Parisa Soltani:
                ORCID: http://orcid.org/0000-0002-9273-5279
                p.soltani@dnt.mui.ac.ir
                Journal
                Journal ID (nlm-ta): BMC Med Imaging
                Journal ID (iso-abbrev): BMC Med Imaging
                Title: BMC Medical Imaging
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2342
                Publication date (Electronic): 12 June 2023
                Publication date PMC-release: 12 June 2023
                Publication date Collection: 2023
                Volume: 23
                Electronic Location Identifier: 78
                Affiliations
                [1 ]GRID grid.411036.1, ISNI 0000 0001 1498 685X, Department of Oral and Maxillofacial Radiology, Dental Implants Research Center, Dental Research Institute, School of Dentistry, , Isfahan University of Medical Sciences, ; Hezar-Jarib Ave, P.O. 8174673461, Isfahan, Iran
                [2 ]GRID grid.411036.1, ISNI 0000 0001 1498 685X, Student Research Committee, School of Dentistry, , Isfahan University of Medical Sciences, ; Isfahan, Iran
                [3 ]GRID grid.4691.a, ISNI 0000 0001 0790 385X, Department of Neurosciences, Reproductive and Odontostomatological Sciences, , University of Naples “Federico II”, ; Naples, Italy
                Author information
                http://orcid.org/0000-0002-9273-5279
                Article
                Publisher ID: 1046
                DOI: 10.1186/s12880-023-01046-x
                PMC ID: 10262476
                PubMed ID: 37308822
                SO-VID: 384c8c61-ccc2-4163-b8a6-1a0670b5f364
                Copyright © © The Author(s) 2023
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 19 August 2022
                Date accepted : 6 June 2023
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100003970, Isfahan University of Medical Sciences;
                Award ID: 399905
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © BioMed Central Ltd., part of Springer Nature 2023

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: cone beam computed tomography,panoramic radiography,bone mineral density,dual energy x-ray absorptiometry,postmenopausal
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: cone beam computed tomography, panoramic radiography, bone mineral density, dual energy x-ray absorptiometry, postmenopausal

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