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Original research article

Diagnostic efficacy of panoramic radiography in detection of osteoporosis in post-menopausal women with low bone mineral density.

Sunanda BhatnagarVasavi KrishnamurthySandeep S Pagare
Department of Oral Medicine and Radiology, Dr. D.Y. Patil Dental College and Hospital, Nerul, Navi Mumbai, India
Date of Submission: 30-Jan-2013, Date of Acceptance: 25-Apr-2013, Date of Web Publication: 06-Jun-2013.
Corresponding Author:
Corresponding Author

Sunanda Bhatnagar

A-401 Sai Paradise, Plot 21, Palm Beach Road, Sector 4, Nerul (West), Navi Mumbai ‑ 400 706, Maharashtra, India.
E-mail: drsunandabhatnagar@yahoo.co.in

Corresponding Author:
Corresponding Author

Sunanda Bhatnagar

A-401 Sai Paradise, Plot 21, Palm Beach Road, Sector 4, Nerul (West), Navi Mumbai ‑ 400 706, Maharashtra, India.
E-mail: drsunandabhatnagar@yahoo.co.in

DOI: 10.4103/2156-7514.113140 Facebook Twitter Google Linkedin


Objective: The aim of the study was to evaluate panoramic radiograph, a commonly taken dental radiograph as a screening tool to detect early osseous changes (normal, mildly or severely eroded) of the mandibular inferior cortex and measure the mandibular cortical width (CW) in post-menopausal women and correlate it with the bone mineral density (BMD) measured by the ultrasound bone sonometer at the mid-shaft tibia region.
Materials and Methods: The study included females between 45 years and 65 years of age in their post-menopausal stage (no menstruation for at least 6-12 months). Mandibular indices (mandibular CW and mandibular cortical shape) were evaluated from panoramic radiographs. The BMD assessment was carried out at the mid-shaft tibia region, exactly half-way between the heel and the knee joint perpendicular to the direction of the bone, using an ultrasound bone sonometer. It is a non-invasive device designed for quantitative measurement of the velocity of ultrasound waves as “speed of sound” in m/s, capable of measuring bone density at one or more skeletal sites. Using 1994 WHO criteria the study subjects were categorized as Group 1: Normal, Group 2: Osteopenia, Group 3: Osteoporosis. (WHO T score for tibia BMD can be used as a standard).
Results: The diagnostic efficacy of the panoramic radiograph in detecting osseous changes in post-menopausal women with low BMD was shown to have 96% specificity and 60% sensitivity with mandibular cortical shape and 58% specificity and 73% sensitivity with mandibular CW measurement. Factorial ANOVA analysis carried out indicated a significant correlation of BMD classification with mandibular cortical shape (F = 29.0, P < 0.001, partial eta squared [η2 ] =0.85), a non-significant correlation with mandibular CW, (F = 1.6, P = 0.23, η2 = 0.86), and a more significant correlation with combined cortical shape and width (F = 3.3, P < 0.05, η2 = 0.70).
Conclusion: The study concludes that the combined mandibular cortical findings (P < 0.05) and mandibular cortical shape erosion alone (P < 0.001) on panoramic radiograph are effective indicators of osteoporosis in post-menopausal women.
Keywords: Mandibular Cortical Shape, Mandibular Cortical Width, Osteoporosis, Panoramic Radiograph

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  2. Eglė Jagelavičienė, Aurelija Krasauskienė, Rimantas Žalinkevičius, Inga Vaitkevičienė and Ričardas Kubilius (2016) Relationship between the mandibular cortical index and calcaneal bone mineral density in postmenopausal women. Medicina 52(2):125. doi: 10.1016/j.medici.2016.02.005
  3. Imad Barngkgei, Esam Halboub, Abeer Abdulkareem Almashraqi, Razan Khattab and Iyad Al Haffar (2016) IDIOS: An innovative index for evaluating dental imaging-based osteoporosis screening indices. Imaging Sci Dent 46(3):185. doi: 10.5624/isd.2016.46.3.185
  4. Khaled Abdullah Balto, Madiha Mahmoud Gomaa, Rabab Mohammed Feteih, Najlaa Mohammed AlAmoudi, Ayman Zaky Elsamanoudy, Mohammed Ahmed Hassanien and Mohammed-Salleh M. Ardawi (2018) Dental Panoramic Radiographic Indices as a Predictor of Osteoporosis in Postmenopausal Saudi Women. J Bone Metab 25(3):165. doi: 10.11005/jbm.2018.25.3.165
  5. Naseem Shah (2014) Recent advances in imaging technologies in dentistry. WJR 6(10):794. doi: 10.4329/wjr.v6.i10.794
  6. Frederico Sampaio Neves, Aline Seixas Barros, Gabriela Almeida Cerqueira, Gabriella Almeida Cruz, Aurélio Amorim Reis, Luciana Bastos Alves and Iêda Crusoé-Rebello (2019) Assessment of fractal dimension and panoramic radiomorphometric indices in women with celiac disease. Oral Radiol :. doi: 10.1007/s11282-019-00388-z
  7. Luciana Munhoz, Arthur R G Cortes and Emiko S Arita (2017) Assessment of osteoporotic alterations in type 2 diabetes: a retrospective study. Dentomaxillofacial Radiology 46(6):20160414. doi: 10.1259/dmfr.20160414
  8. Olja Grgić, Branka Kovačev-Zavišić, Tanja Veljović, Jovanka Novaković-Paro, Tatjana Maravić and Branislav Bajkin (2017) The influence of bone mineral density and bisphosphonate therapy on the determinants of oral health and changes on dental panoramic radiographs in postmenopausal women. Clin Oral Invest 21(1):151. doi: 10.1007/s00784-016-1767-6
  9. Lingyu Hao, Jiayao Fu, Yawen Tian and Junhua Wu (2017) Systematic analysis of lncRNAs, miRNAs and mRNAs for the identification of biomarkers for osteoporosis in the mandible of ovariectomized mice. 40(3):689. doi: 10.3892/ijmm.2017.3062
  10. C. B. Brasileiro, L. L. F. H. Chalub, M. H. N. G. Abreu, I. D Barreiros, T. M. P. Amaral, A. M. Kakehasi and R. A. Mesquita (2017) Use of cone beam computed tomography in identifying postmenopausal women with osteoporosis. Arch Osteoporos 12(1):. doi: 10.1007/s11657-017-0314-7

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