Radiomorphometric Indicators, their Reliability in Detecting Early Signs of Osteoporosis in Menopausal Women

Abstract

Background: The aim of this study was to evaluate the diagnostic value of panoramic radiography and the radiomorphometric indices in osteoporosis identification. Methods and Results: The research included 60 women (average age of 62,907,07 years) in the postmenopausal stage who were subjected to an assessment of bone density through the DEXA test and were divided into 2 groups based on the value of the DEXA test from the lumbar region (L1-L4): Main group (MG) included 30 women with osteoporosis (T-score<-2.5) and Comparison group (CG) included 30 women without osteoporosis (T-score>-2.5). Panoramic radiography were used to assess the mandibular cortical index (MCI), mental index (MI), panoramic mandibular index (PMI) Based on the porosity level, Klemetti et al.(1994) has categorized MCI into three categories (C1, C2, and C3). MCI–C1, which represents the normal appearance of the lower jaw cortex without changes in bone quality, was found only in CG in 63.33%. MCI-C2 and MCI-C3 were found in 70% and 30% of cases, respectively, in MG. In CG, MCI-C2 was found in 36.67% of cases and MCI-C3 in 0% of cases. There was a significant difference between the two study groups in the distribution of MCI (P=0.000). MI below 3 mm was found in 19(63.33%) of cases in CG and 27(90.00%) in MG (OR=5.211, 95% CI: 1.278-21.237, P=0.0213). PMI below 0.3mm was found in 7(23.33%) of cases in CG and 19(63.33%) in MG (OR=5.675 95% CI: 1.841-17.494, P=0.0025). MCI sensitivity and specificity for osteoporosis were 70% (95% CI: 50.60%-85.27%) and 63.33% (95% CI: 43.86%-80.07%), respectively; PPV, NPV, and accuracy were 65.62% (95% CI: 53.03%-76.35%), 67.86% (95% CI: 53.41%-79.54%) and 66.67% (95% CI: 53.31%-78.31%), respectively. MI sensitivity and specificity at a cutoff point of 3 mm for osteoporosis were 90% (95% CI: 73.47%-97.89%) and 36.67% (95% CI: 19.93%-56.14%), respectively; PPV, NPV, and diagnostic accuracy were 58.70% (95% CI: 51.35%-65.67%), 78.57% (95% CI: 53.18%-92.21%) and 63.33% (95% CI: 49.90%-75.41%), respectively. PMI sensitivity and specificity at a cutoff point of 0.3 mm for osteoporosis were 63.33% (95% CI: 43.86%-80.07%) and 76.67% (95% CI: 57.72%-90.07%), respectively; PPV, NPV, and diagnostic accuracy were 73.08% (95% CI: 57.32%-84.58%), 67.65% (95% CI: 55.66%-77.69%) and 70.00% (95% CI: 56.79%-81.15%), respectively. Conclusion: PR can be a useful tool to identify early signs of osteoporosis by using the evaluation of radiomorphometric indices. MCI, MI, and PMI can be potential screening tools for initial BMD loss.