Research Information System
Journal of Oral and Maxillofacial Surgery; 2013: Vol. 71 Issue 9, e13. (DOI: https://doi.org/10.1016/j.joms.2013.06.024 ) / 95th Annual Meeting of American Association of Oral and Maxillofacial Surgeons, Florida, United States Of America, 7 - 12 October 2013, pp.13
Osteoporosis is characterized as loss of bone mineral
density and deterioration of bone architecture, with consequent
susceptibility to fractures, even with minimal
force. Early detection of osteoporosis is an important
public health goal because interventions such as drug
therapy, exercise, and fall-prevention measures can be effective
in preventing fractures. The acceleration of bone
degeneration during menopause causes post-menopausal
women to be especially prone to complications arising
from osteoporosis. Dental radiographs have great potential
as a screening tool for osteoporosis because of their
wide availability, practicality, and low cost. Their performance
as screening tools, however, has yielded conflicting
results.1,2 The purpose of this study was to answer
the following clinical question: ‘‘Do certain features of
dental panoramic radiographs correlate strongly with
the presence of osteoporosis in post-menopausal
women?’’ The authors hypothesize that there will be identifiable
radiographic features that may aid in screening for
osteoporosis in this population. The specific aims of this
study were to 1) To develop and implement a retrospective
cohort study and to enroll subjects who were postmenopausal
women with bone mineral density (BMD)
measurements and panoramic dental x-rays; and 2) To
identify which measurements taken from the panoramic
x-rays can be used to screen post-menopausal women for
osteoporosis.
Using a retrospective cohort study design, the authors
enrolled a sample composed of female subjects
who were 50 years of age or older and had a dental
panoramic x-ray and a bone mineral density scan
within two years of each other at the Massachusetts
General Hospital between 2006 and 2012. The predictor
variables were average gonial angle, average antegonial
angle, mandibular cortical bone integrity,
periodontal disease status, and number of remaining
teeth. In addition, demographic (age, ethnicity) and
medical data (BMI, bisphosphonate usage) were obtained
as additional predictor variables. The primary
outcome measure was BMD T-score as determined by
dual emission x-ray absorptiometry, the gold standard
for diagnosing osteoporosis.
Descriptive and logistic regression statistics were computed
to analyze the relationship between the predictor
variables and decreased BMD. P-values < 0.05 were considered
significant. The sample was composed of 274 subjects
with a mean age of 64 9.3 years. The average BMD
T-score was -1.59 1.11. The sample was composed of
27.11% normal (BMD T-score > -1), 50.92% osteopenic
(BMD T-score between -1 and -2.5), and 21.98% osteoporotic
(BMD T-score < -2.5). Of the predictor variables examined,
mandibular cortical bone integrity (p=0.019),
age (p<0.0001), BMI (p<0.0001), and bisphosphonate usage
(p=0.037) showed significant correlations with
a BMD diagnosis of osteopenia/osteoporosis. Average gonial
angle (p= 0.5), average antegonial angle (p=0.2),
number of remaining teeth (p=0.1) and periodontal status
(p=0.3) did not demonstrate significance. In a multivariate
logistic regression analysis, mandibular cortical
bone outline did not demonstrate significance (p= 0.6),
while age and BMI remained significant (p<0.0001). In
conclusion, given mandibular cortical bone integrity’s
significance in univariate analysis and biologic plausibility,
it may be useful as a risk assessment tool and recommendation
for a bone mineral density scan, while other
panoramic measurements (gonial angle, antegonial angle,
periodontal status) have limited utility as screening tools.