ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Morphology of Mandibular Inferior Cortex in Panoramic Radiograph Can Help Diagnose Osteoporosis in Post Menopausal Women
Clinical Question In postmenopausal women can the morphology of the mandibular inferior cortex be used as a screening tool aiding in the diagnosis of osteoporosis?
Clinical Bottom Line Evidence shows that Eroded Appearance of the Inferior Mandibular cortex in a panoramic radiograph is an Effective Indicator for osteoporosis in postmenopausal women.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 15547223Taguchi/2004316 women with a mean age 56.8 were recruited for this study subjects were divided into Two Groups: 159 Healthy postmenopausal women (Group A) and 157 Post Menopausal women with histories of hysterectomy, oophorectomy, or estrogen use (Group B). Subjects had a diagnostic performances of panoramic measurements, Bone Mineral Density (BMD) at the lumber Spine (L2-L4) was measured by Dual –Energy X-ray Absorptiometry In vivo study Clinical trial
Key resultsDual Energy X ray Absorptiometry (DXA) of the Lumbar Spines (Bone Mineral Density) is the Gold Standard for Diagnosing Osteoporosis. Study group was categorized into 3 skeletal mineral density classes based on World Health Organization criteria: Normal (t score >-1.0); Osteopenic (t score -1.0 to -2.5); Osteoporosis (t score < -2.5). Assessment of mandibular cortical shape was determined by observing mandible distal from mental foramen bilaterally and categorized into three groups based on Klemetti et al. as follows: Normal cortex, mild to moderate eroded cortex, or severely eroded cortex with clear porous. Sensitivity, Specificity, Positive predictive value and Negative predictive value for identifying women with spinal osteoporosis were 86.8%, 63.6%, 42.9% and 93.9%, respectively for Cortical Shape in healthy menopausal women. Sensitivity, Specificity, Positive predictive value and Negative predictive value were 80.0%, 64.1%, 43.2 and 90.4%, respectively in postmenopausal women with history of Hysterectomy, oophorectomy, or estrogen use. Overall Agreements for Intra observer and inter observer performances were 92% and 82%, respectively These results suggest that Post menopausal Women with spinal osteoporosis who should undergo BMD testing may be identified by mandibular cortical shape.
#2) 23811576Mansour /2013100 Self Reported Women Ages >30 mean Age is 52.2, received Digital Panoramic images and Bone Mineral Density (BMD) of Lumbar Supine L2 to L4 were recorded using Dual-Energy X ray Absorptiometry (DXA).In vivo, Prospective Study
Key resultsDual Energy X ray Absorptiometry (DXA) of the Lumbar Spines (Bone Mineral Density) is the Gold Standard for Diagnosing Osteoporosis. Study groups was categorized into 3 skeletal mineral density groups based on World Health Organization criteria: Normal (t score >-1); Osteopenic (t score -1 to -2.5); Osteoporosis (t score < -2.5). On Panoramic Radiograph Indices of Mandibular Cortical Index was determined as C1 (Normal), C2 (Osteopenic), C3(Osteoporotic) by examining the inferior cortex of mandible from mental foramen to antegonial area on both sides. BMD results were 61% Normal t score >-1; 34% Osteopenic t score of -1 and > 2.5; 5% had a t score of <2.5. MCI Score 59% C1 Normal; 38% C2 Osteopenic; 3% C3 Osteoporosis. Inter observer agreement were kappa 0.922 for MCI. Sensitivity- 66.7%%, Specificity- 75.4. This Indicates MCI was Positively correlated with t score and BMD of the Lumber Spines and reproducible Index.
Evidence Search Mandibular Cortical Index Diagnosing Osteoporosis in postmenopausal women
Comments on
The Evidence
Validity: Both Studies were well designed, and the sample size was very good. Taguchi study showed that another method for screening for osteoporosis is using inferior mandibular cortical width, but it showed a relatively low specificity 33.9% and a high sensitivity of 89.%. Mansour study also used deferent panoramic radiomorphometric indices like Mental index and panoramic mandibular index and found positive correlation with BMD of lumber spines but still found Mandibular cortical index was the most reproducible index. Both studies showed that a conventional panoramic radiograph can be used as a screening tool for osteoporosis
Applicability Dental Panoramic Radiograph can be a useful tool for detecting those at high risk for osteoporosis. Dentists may be able to refer asymptomatic post menopausal women with suspected spinal osteoporosis for bone densitometry based on findings in dental panoramic radiographs based on eroded appearance of the inferior mandibular cortex.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery)
Keywords Mandibular Cortical Index; Osteoporosis; Postmenopausal Women; Morphology of Mandibular Cortex; DXA
ID# 2545
Date of submission: 08/16/2013spacer
E-mail alsaati@livemail.uthscsa.edu
Author Mohammed Alsaati, DDS
Co-author(s) Jelena Seibold, DDS
Co-author(s) e-mail seibold@livemail.uthscsa.edu
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
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