Is jaw fractal dimension a reliable biomarker for osteoporosis screening? A systematic review and meta-analysis of diagnostic test accuracy studies.

Abstract

To summarize the evidence on the feasibility of maxillomandibular imaging exams-related fractal dimension (FD) in screening patients with osteoporosis. This registered systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy statement. High sensitivity search strategies were developed for six primary databases and grey literature. Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) items evaluated the risk of bias, and the GRADE approach assessed the evidence certainty. From 1034 records initially identified through database searching, four studies were included (total sample of 747 patients [osteoporosis, 136; control group, 611]). The meta-analysis showed that the overall sensitivity and specificity of the FD were 86.17 and 72.68%, respectively. In general, all studies showed low RoB and applicability concern. The certainty of the evidence was very low to moderate. This systematic review showed that the jaw-related FD presented sensitivity and specificity values higher than 70%, and its sensitivity in osteoporosis screening was a better parameter than specificity.