Abstract
Objective
To verify whether mandibular cortical analyses accurately distinguish postmenopausal women with normal bone mineral density (BMD) from women with osteoporosis by means of a cone-beam computed tomography (CBCT)–driven composite osteoporosis index (three-dimensional mandibular osteoporosis index—3D MOI).
Material and methods
The comparison was performed between 52 women with normal BMD and 51 women with osteoporosis according to dual-energy X-ray absorptiometry (DXA) examination of the lumbar spine and hip. Mandibular cortical width (MCW) and cortical quality were evaluated on cross-sectional and panoramic reconstructed images. ANOVA, ROC curves and accuracy measurements were used for statistical analyses, as well as a predictive model combining the quantitative and qualitative analyses and age.
Results
All CBCT-driven measurements presented good to moderate intra- and interobserver agreements. MCW values were significantly lower in women with osteoporosis. Postmenopausal women with osteoporosis were 8 times more likely to have the cortex classified as C3, and 2.4 times more likely to have MCW thinner than 2.75 mm. The area under the ROC curve was 0.8 for the predictive model.
Conclusions
The newly developed 3D MOI enables distinguishing women with osteoporosis from those with normal BMD with good sensitivity and specificity.
Clinical relevance
Whenever a CBCT scan is performed for specific clinical indications, a 3D MOI may be performed to qualitatively and quantitatively assess the condition of the mandibular cortex. This may be surely helpful to assess the osteoporosis status in the ageing population and more specifically in peri- or postmenopausal women.
Similar content being viewed by others
References
National Institutes of Health (2001) Consensus Panel on osteoporosis prevention, diagnosis, and therapy. JAMA 285:785–795
Atik OS, Gunal I, Korkusuz F (2006) Burden of osteoporosis. Clin Orthop Relat Res 443:19–24
Høiberg MP, Rubin KH, Hermann AP, Brixen K, Abrahamsen B (2016) Diagnostic devices for osteoporosis in the general population: a systematic review. Bone 92:58–69
Klemetti E, Kolmakov S, Kroger H (1994) Pantomography in assessment of the osteoporosis risk group. Scand J Dent Res 102:68–72
Taguchi A, Tanimoto K, Suei Y, Wada T (1995) Tooth loss and mandibular osteopenia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 79:127–132
Taguchi A, Suei Y, Sanada M, Ohtsuka M, Nakamoto T, Sumida H et al (2004) Validation of dental panoramic radiography measures for identifying postmenopausal women with spinal osteoporosis. AJR Am J Roentgenol 183:1755–1760
Lindh C, Horner K, Jonasson G, Olsson P, Rohlin M, Jacobs R, Karayianni K, van der Stelt P, Adams J, Marjanovic E, Pavitt S, Devlin H (2008) The use of visual assessment of dental radiographs for identifying women at risk of having osteoporosis: the OSTEODENT project. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106:285–293
Nackaerts O, Jacobs R, Devlin H, Pavitt S, Bleyen E, Yan B et al (2008) Osteoporosis detection using intraoral densitometry. Dentomaxillofac Radiol 37:282–287
Horner K, Allen P, Graham J, Jacobs R, Boonen S, Pavitt S et al (2010) The relationship between the OSTEODENT index and hip fracture risk assessment using FRAX. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 110:243–249
Leite AF, Figueiredo PT, Guia CM, Melo NS, de Paula AP (2010) Correlations between seven panoramic radiomorphometric indices and bone mineral density in postmenopausal women. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:449–456
Alman AC, Johnson LR, Calverley DC, Grunwald GK, Lezotte DC, Hokanson JE (2012) Diagnostic capabilities of fractal dimension and mandibular cortical width to identify men and women with decreased bone mineral density. Osteoporos Int 23:1631–1636
Sindeaux R, Figueiredo PT, de Melo NS, Guimarães AT, Lazarte L, Pereira FB, de Paula AP, Leite AF (2014) Fractal dimension and mandibular cortical width in normal and osteoporotic men and women. Maturitas 77:142–148
Koh KJ, Kim KA (2011) Utility of the computed tomography indices on cone beam computed tomography images in the diagnosis of osteoporosis in women. Imaging Sci Dent 41:101–106
Güngör E, Yildirim D, Çevik R (2016) Evaluation of osteoporosis in jaw bones using cone beam CT and dual-energy X-ray absorptiometry. J Oral Sci 58:185–194
Mostafa RA, Arnout EA, Abo El-Fotouh MM (2016) Feasibility of cone beam computed tomography radiomorphometric analysis and fractal dimension in assessment of postmenopausal osteoporosis in correlation with dual X-ray absorptiometry. Dentomaxillofac Radiol 45:20160212
Brasileiro CB, Chalub LLFH, Abreu MHNG, Barreiros ID, Amaral TMP, Kakehasi AM, Mesquita RA (2017) Use of cone beam computed tomography in identifying postmenopausal women with osteoporosis. Arch Osteoporos 12:26
Kato CN, Tavares NP, Barra SG, Amaral TM, Brasileiro CB, Abreu LG, Mesquita RA (2019) Digital panoramic radiography and cone-beam CT as ancillary tools to detect low bone mineral density in post-menopausal women. Dentomaxillofac Radiol 48:20180254
Bornstein MM, Scarfe WC, Vaughn VM, Jacobs R (2014) Cone beam computed tomography in implant dentistry: a systematic review focusing on guidelines, indications, and radiation dose risks. Int J Oral Maxillofac Implants 29(Suppl):55–77
Yepes JF, Al-Sabbagh M (2015) Use of cone-beam computed tomography in early detection of implant failure. Dent Clin N Am 59:41–56
World Health Organization (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 843:1–129
Diniz-Freitas M, Fernández-Montenegro P, Fernández-Feijoo J, Limeres-Posse J, González-Mosquera A, Vázquez-García E, Diz-Dios P (2016) Mandibular cortical indices on cone-beam computed tomography images in osteoporotic women on treatment with oral bisphosphonates. Gerodontology 33:155–160
Gomes CC, de Rezende Barbosa GL, Bello RP, Bóscolo FN, de Almeida SM (2014) A comparison of the mandibular index on panoramic and cross-sectional images from CBCT exams from osteoporosis risk group. Osteoporos Int 25:1885–1890
Alonso MB, Vasconcelos TV, Lopes LJ, Watanabe PC, Freitas DQ (2016) Validation of cone-beam computed tomography as a predictor of osteoporosis using the Klemetti classification. Braz Oral Res 30(1):S1806-83242016000100263
Greiner M, Pfeiffer D, Smith RD (2000) Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests. Prev Vet Med 45:23–41
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Chen C, Barnhart HX (2013) Assessing agreement with intraclass correlation coefficient and concordance correlation coefficient for data with repeated measures. Comp Stat Data Anal 60:132–145
Taguchi A, Suei Y, Ohtsuka M, Otani K, Tanimoto K, Ohtaki M (1996) Usefulness of panoramic radiography in the diagnosis of postmenopausal osteoporosis in women. Width and morphology of inferior cortex of the mandible. Dentomaxillofac Radiol 25:263–267
Jowitt N, MacFarlane T, Devlin H, Klemetti E, Horner K (1999) The reproducibility of the mandibular cortical index. Dentomaxillofac Radiol 28:141–144
Devlin H, Horner K (2002) Mandibular radiomorphometric indices in the diagnosis of reduced skeletal bone mineral density. Osteoporos Int 13:373–378
Funding
The study received financial support from Fundação de Apoio à Pesquisa do Distrito Federal–FAP-DF.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
de Castro, J.G.K., Carvalho, B.F., de Melo, N.S. et al. A new cone-beam computed tomography–driven index for osteoporosis prediction. Clin Oral Invest 24, 3193–3202 (2020). https://doi.org/10.1007/s00784-019-03193-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00784-019-03193-4