Identifying dental panoramic radiographic features for the screening of osteoporosis in post-menopausal women.

Geary S., Selvi F., Chuang S. -., August M.

Journal of Oral and Maxillofacial Surgery; 2013: Vol. 71 Issue 9, e13. (DOI: ) / 95th Annual Meeting of American Association of Oral and Maxillofacial Surgeons, Florida, United States Of America, 7 - 12 October 2013, pp.13

  • Publication Type: Conference Paper / Summary Text
  • Doi Number: 10.1016/j.joms.2013.06.024
  • City: Florida
  • Country: United States Of America
  • Page Numbers: pp.13
  • Istanbul University Affiliated: Yes


 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


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.