Prediction of bone mineral density with dental radiographs
Introduction
Osteoporosis is a systemic disease characterized by low bone mineral density (BMD), deterioration of bone structure, and increased bone fragility according to the definition of the World Health Organization (WHO) formulated in 1994 [1], [2], [3]. An expert group under the WHO recommended to base the diagnosis of osteoporosis on measurements of BMD in the hip, spine, or lower arm by means of dual X-ray absorptiometry (DXA) [4].
Annual screening of all postmenopausal women is not recommended because it involves high costs and it has low sensitivity [3], [5]. However, it is suggested that BMD should be measured if an additional risk factor is present such as low weight or age 65 and over [4]. This still involves high costs and many facilities. Thus for screening purposes an inexpensive alternative method of assessing skeletal status is required [3]. Dental radiographs are relatively inexpensive and already made routinely in a large part of the adult population. Therefore, dental radiographs might represent an enormous potential as a screening tool for osteoporosis. The general dental practitioner might fulfil the same role with respect to osteoporosis as for example in the early diagnosis of oral cancer [6].
As osteoporosis is a systemic skeletal disease, it also affects bone density and structure of the jaws. Several review articles describe the use of dental radiographs for diagnosing osteoporosis [7], [8], [9]. Osteoporotic patients have reduced bone mass of the jaws [10], [11], [12], [13], [14]. Extensive morphologic analysis of the trabecular pattern on dental radiographs in relation to osteoporosis is also described [15], [16]. The relations between BMD and age, sex, weight, and ethnic background are too weak to allow precise prediction of BMD. The objective of the present study is to investigate the contribution of morphologic image features measured on panoramic and intraoral dental radiographs to the prediction of BMD of hip and spine.
Section snippets
Subjects
In the Osteodent project subjects from Manchester, Athens, Leuven, and Malmö were invited to participate in the study by means of articles in the local press, flyers, and by oral communication. In the project, 671 women in the age range of 39 to 71 years (average 54.6 years) were recruited. Women with possible secondary osteoporosis, primary hyperparathyroidism, poorly controlled thyrotoxicosis, malabsorption, liver disease, and alcoholism were excluded. Informed consent was obtained from all
Results
Of the subjects involved in the study, 20% were classified as having osteoporosis of the left hip or of the spine. Table 1 presents an overview of the numbers of healthy, osteopenic, and osteoporotic subjects. It clearly shows a decreasing number of healthy subjects and an increasing number of osteoporotic subjects with increasing age.
Main conclusion
When the prediction of total hip BMD or spinal BMD by means of age is taken as a reference, it is found that the predictive validity is approximately doubled by using the image features of dental radiographs. We found that age alone explains 10% of the variance in total hip BMD and 14% of the variance in spinal BMD (Table 2). Each of the three radiographs raised the percentage of explained variance with a statistically significant amount. Therefore, the overall conclusion from our findings is
Acknowledgment
This work was supported by a research and technological development project grant from the European Commission Fifth Framework Programme ‘Quality of Life and Management of Living Resources’ (QLK6-2002-02243; ‘Osteodent’).
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