Abstract
Purpose of Review
Osteoporosis ranks high among morbidities in the elderly as it is a natural process to lose bone, making them susceptible to fractures from minor falls. The cost of managing these patients is staggering. The fractures can be prevented with better care of the elderly, and by treating the major predisposing factor, osteoporosis. Clinicians and scientists, in general, constantly look for early diagnostic and prognostic indicators for osteopenia and osteoporosis to proactively prevent fractures. Dental panoramic radiography (DPR) is a rotational pantomography used for identifying dental pathology in patients. Early signs of osteopenia and osteoporosis can be identified in DPR. The usefulness of notable jaw changes in DPR to predict osteopenia and osteoporosis is still evolving as more studies continue to delve into this concept. The purpose of this review is to present advances made in the practical application of DPR for predicting early onset of osteopenia and osteoporosis.
Recent Findings
Dental panoramic radiography, a form of tomography commonly used by dental practitioners, has been the standard of care for decades for detecting dento-alveolar pathology. Several technological advancements have taken place with respect to the use of DPR. These include conversion from plain film to digital radiography, advancements in the manufacture of flat panel detectors, and accurate imaging of the layers of mandible and maxilla that has become possible with appropriate patient positioning within the focal trough of the machine. Improvements in the software infrastructure make it easier to view, enhance, and save the radiographic images. The radiographic appearance of the trabecular bone within the mandible and indices measured from the dental panoramic radiographs focusing on the inferior cortex of the mandible are considered useful tools for identifying asymptomatic individuals with osteoporosis or at risk for developing osteoporosis. These indices apparently correlate with risks of fragility fractures of osteoporosis in other parts of the body.
Summary
Dental panoramic radiography (DPR) is a commonly used radiographic procedure in dentistry for evaluation of teeth and associated maxillofacial structures. The evaluation of the inferior border of the mandible for reduction or loss of cortical thickness and evaluation of the trabecular bone within the mandible are helpful markers for early signs of osteopenia to identify patients at risk for osteoporosis. This review focused on research advancements on practical application of DPR in early identification of osteopenia and osteoporosis.
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References
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NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001;285(6):785–95. https://doi.org/10.1001/jama.285.6.785.
Cauley JA, Chalhoub D, Kassem AM, Gel-H Fuleihan. Geographic and ethnic disparities in osteoporotic fractures. Nat Rev Endocrinol. 2014;10(6):338–51.
Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, Dawson-Hughes B. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res. 2014;29(11):2520–6. https://doi.org/10.1002/jbmr.2269.
Barnsley J, Buckland G, Chan PE, Ong A, Ramos AS, Baxter M, Laskou F, Dennison EM, Cooper C, Patel HP. Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people. Aging Clin Exp Res. 2021;33(4):759–73.
Föger-Samwald U, Dovjak P, Azizi-Semrad U, Kerschan-Schindl K, Pietschmann P. Osteoporosis: Pathophysiology and therapeutic options. EXCLI J. 2020;20(19):1017–37.
Akintoye SO, Lam T, Shi S, Brahim J, Collins MT, Robey PG. Skeletal site-specific characterization of orofacial and iliac crest human bone marrow stromal cells in same individuals. Bone. 2006;38(6):758–68. https://doi.org/10.1016/j.bone.2005.10.027.
Akintoye SO. The distinctive jaw and alveolar bone regeneration. Oral Dis. 2018;24(1–2):49–51.
Osyczka AM, Damek-Poprawa M, Wojtowicz A, Akintoye SO. Age and skeletal sites affect BMP-2 responsiveness of human bone marrow stromal cells. Connect Tissue Res. 2009;50(4):270–7.
Omolehinwa TT, Akintoye SO. Chemical and radiation-associated jaw lesions. Dent Clin North Am. 2016;60(1):265–77.
Akintoye S. Osteonecrosis of the jaw from bone anti-resorptives: impact of skeletal site-dependent mesenchymal stem cells. Oral Dis. 2014;20(2):221–2. https://doi.org/10.1111/odi.12181.
Sarin J, DeRossi SS, Akintoye SO. Updates on bisphosphonates and potential pathobiology of bisphosphonate-induced jaw osteonecrosis. Oral Dis. 2008;14(3):277–85.
FRAX®. Fracture risk assessment tool. Center for metabolic bone diseases, University of Sheffield, UK. Available at: https://www.sheffield.ac.uk/FRAX/. Accessed on 12 Nov 2022.
•• Yeung AWK, Mozos I. The innovative and sustainable use of dental panoramic radiographs for the detection of osteoporosis. Int J Environ Res Public Health. 2020;17(7):2449. (The work of Yeung and Mozos [2020] acknowledged the relevance of panoramic radiographic-based indices among researchers worldwide. They reiterated that although the literature from the 1970s and 1980s laid the groundwork for the investigation into the utilization of morphometric indices, more recent publications indicated that the dental panoramic radiography was a tool to identify subjects at risk of developing osteoporosis and can be used as a screening tool.)
Mupparapu M, Nadeau C. Oral and maxillofacial imaging. Dent Clin North Am. 2016;60(1):1–37.
Osterhoff G, Morgan EF, Shefelbine SJ, Karim L, McNamara LM, Augat P. Bone mechanical properties and changes with osteoporosis. Injury. 2016;47(Suppl 2):S11–20.
Lindh C, Nilsson M, Klinge B, Petersson A. Quantitative computed tomography of trabecular bone in the mandible. Dentomaxillofac Radiol. 1996;25(3):146–50.
Taguchi A, Ohtsuka M, Tsuda M, Nakamoto T, Kodama I, Inagaki K, Noguchi T, Kudo Y, Suei Y, Tanimoto K. Risk of vertebral osteoporosis in post-menopausal women with alterations of the mandible. Dentomaxillofac Radiol. 2007;36(3):143–8.
Taguchi A. Triage screening for osteoporosis in dental clinics using panoramic radiographs. Oral Dis. 2010;16(4):316–27.
Kavitha MS, Samopa F, Asano A, Taguchi A, Sanada M. Computer-aided measurement of mandibular cortical width on dental panoramic radiographs for identifying osteoporosis. J Investig Clin Dent. 2012;3(1):36–44.
• Nakamoto T, Hatsuta S, Yagi S, Verdonschot RG, Taguchi A, Kakimoto N. Computer-aided diagnosis system for osteoporosis based on quantitative evaluation of mandibular lower border porosity using panoramic radiographs. Dentomaxillofac Radiol. 2020;49(4):20190481. (The work of Nakamoto and colleagues [2020] investigated potential signs of osteopenia in panoramic radiographs via computer-aided detection specifically, mandibular lower border porosity. The mandibular cortical indices play a major role in determining the risk for osteoporosis. The authors tried to eliminate the subjectivity in assessment by utilizing computer-aided detection.)
Mohajery M, Brooks SL. Oral radiographs in the detection of early signs of osteoporosis. Oral Surg Oral Med Oral Pathol. 1992;73(1):112–7.
Kwon AY, Huh KH, Yi WJ, Lee SS, Choi SC, Heo MS. Is the panoramic mandibular index useful for bone quality evaluation? Imaging Sci Dent. 2017;47(2):87–92.
Carmo JZB, Medeiros SF. Mandibular inferior cortex erosion on dental panoramic radiograph as a sign of low bone mineral density in postmenopausal women. Rev Bras Ginecol Obstet. 2017;39(12):663–9.
Taguchi A, Suei Y, Sanada M, Ohtsuka M, Nakamoto T, Sumida H, Ohama K, Tanimoto K. Validation of dental panoramic radiography measures for identifying postmenopausal women with spinal osteoporosis. AJR Am J Roentgenol. 2004;183(6):1755–60.
• Ren J, Fan H, Yang J, Ling H. Detection of trabecular landmarks for osteoporosis prescreening in dental panoramic radiographs. Annu Int Conf IEEE Eng Med Biol Soc. 2020;2020:2194–7. (The work of Ren and colleagues [2020] investigated the use of trabecular changes noted in panoramic radiography that would determine the risk of an individual for osteoporosis.)
• Tanaka R, Tanaka T, Yeung AWK, Taguchi A, Katsumata A, Bornstein MM. Mandibular radiomorphometric indices and tooth loss as predictors for the risk of osteoporosis using panoramic radiographs. Oral Health Prev Dent. 2020;18(1):773–82. (Tanaka R and colleagues [2021] investigated the use of panoramic radiography-based radiomorphometric indices in combination with tooth loss for determination of the risk of osteoporosis. It is now known that tooth loss is also another factor in addition to signs of osteopenia in the dental panoramic radiographs alerting clinicians of the high risk for osteoporosis among these individuals.)
Franciotti R, Moharrami M, Quaranta A, Bizzoca ME, Piattelli A, Aprile G, Perrotti V. Use of fractal analysis in dental images for osteoporosis detection: a systematic review and meta-analysis. Osteoporosis Int. 2021;32(6):1041–52.
Calciolari E, Donos N, Park JC, Petrie A, Mardas N. Panoramic measures for oral bone mass in detecting osteoporosis: a systematic review and meta-analysis. J Dent Res. 2015;94(3 Suppl):17S-27S.
Klemetti E, Kolmakov S, Heiskanen P, Vainio P, Lassila V. Panoramic mandibular index and bone mineral densities in postmenopausal women. Oral Surg Oral Med Oral Pathol. 1993;75(6):774–9. https://doi.org/10.1016/0030-4220(93)90438-a.
Klemetti E, Kolmakov S, Kröger H. Pantomography in assessment of the osteoporosis risk group. Scand J Dent Res. 1994;102(1):68–72.
Benson BW, Prihoda TJ, Glass BJ. Variations in adult cortical bone mass as measured by a panoramic mandibular index. Oral Surg Oral Med Oral Pathol. 1991;71(3):349–56. https://doi.org/10.1016/0030-4220(91)90314-3.
Larheim TA, Svanaes DB. Reproducibility of rotational panoramic radiography: mandibular linear dimensions and angles. Am J Orthod Dentofacial Orthop. 1986;90(1):45–51.
Güngör K, Akarslan Z, Akdevelioglu M, Erten H, Semiz M. The precision of the panoramic mandibular index. Dentomaxillofac Radiol. 2006;35(6):442–6.
Ledgerton D, Horner K, Devlin H, Worthington H. Panoramic mandibular index as a radiomorphometric tool: an assessment of precision. Dentomaxillofac Radiol. 1997;26(2):95–100.
Hastar E, Yilmaz HH, Orhan H. Evaluation of mental index, mandibular cortical index and panoramic mandibular index on dental panoramic radiographs in the elderly. Eur J Dent. 2011;5(1):60–7.
Funding
This review was supported in part by grant R01CA259307 (awarded to S. O. A.) by the US Department of Health and Human Services/National Institutes of Health, Bethesda, MD.
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Dr. Sunday O. Akintoye (author #2) is the co-section editor for the Craniofacial skeleton section of Current Osteoporosis Reports.
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Mupparapu, M., Akintoye, S.O. Application of Panoramic Radiography in the Detection of Osteopenia and Osteoporosis—Current State of the Art. Curr Osteoporos Rep 21, 354–359 (2023). https://doi.org/10.1007/s11914-023-00807-5
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DOI: https://doi.org/10.1007/s11914-023-00807-5