Advertisement

Osteoporosis International

, Volume 16, Issue 8, pp 999–1003 | Cite as

Comparison between the Klemetti index and heel DXA BMD measurements in the diagnosis of reduced skeletal bone mineral density in the elderly

  • Anders Halling
  • G. Rutger Persson
  • Johan Berglund
  • Owe Johansson
  • Stefan Renvert
Original Article

Abstract

Osteopenia/osteoporosis affect many elderly people and might not be detected until symptoms of fractures occur. Early detection of osteopenia/osteoporosis is important and would allow preventive measures and treatment. Access to screening for osteopenia/osteoporosis is often limited, whereas panoramic radiography is commonly used in dentistry. The aim of this study was to determine the validity of the Klemetti index (KI), measured on panoramic radiographs, in the diagnosis of osteopenia/osteoporosis as defined by a bone mineral density (BMD) measurement below −1.5 standard deviations (SDs) of a community based sample. In total, 211 consecutive participants (102 men and 109 women) 60–96 years in the SNAC–Blekinge study (Swedish National Study on Ageing and Care) underwent bone densitometry [by dual-energy X-ray absorptiometry (DXA)] of both heels. A panoramic radiograph was taken of each participant, and mandibular cortex on a panoramic radiograph was classified as ‘0’ or normal (even and sharp endosteal margin), ‘1’, moderately eroded (evidence of lacunar resorption or endosteal cortical residues), or ‘2’, severely eroded (unequivocal porosity). From logistic regression, the odds ratio of having a BMD measurement below −1.5 SD was 8.04 (95% CI 2.39 to 27.12, P<0.001) in the ‘osteopenic’ (KI category 2), compared with the ‘normal’ group (KI categories 0 and 1). Receiver operating characteristic (ROC) curve analysis was used to measure the validity of the KI indicating osteopenia (KI category 2) in predicting reduced BMD. This point provided a sensitivity of 50% and a specificity of 89%. Positive and negative predictive values were 21% and 97%, respectively. There were 87% correctly classified subjects. The area under the ROC curve was 0.64. The present study demonstrated that a negative finding (KI category <2) is highly predictive of the absence of osteopenia/osteoporosis as defined by the DXA measurements.

Keywords

Klemetti index Osteoporosis Panoramic Radiography 

Notes

Acknowledgements

We thank Dr. R.E. Persson for help in validating the radiographic measurements. We are grateful to the staff and participants of SNAC–Blekinge for their help and interest in the study. We also thank the Swedish Ministry of Health and Social Affairs, Blekinge Institute of Technology, Kristianstad University, Blekinge County Council and Blekinge Institute for Research and Development for funding this study.

References

  1. 1.
    National Institute of Arthritis (2000) Musculoskeletal and skin diseaseshttp://www.nih.gov/niams/healthinfo/opbkr. htm
  2. 2.
    Kanis JA, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A (2000) Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone 27:585–590CrossRefPubMedGoogle Scholar
  3. 3.
    Löfman O, Larsson L, Toss G (2000) Bone mineral density in diagnosis of osteoporosis: reference population, definition of peak bone mass, and measured site determine prevalence. J Clin Densitom 3:177–186PubMedGoogle Scholar
  4. 4.
    Eddy DM, Johnston CC, Cummings SR, Dawson-Hughes B, Lindsay R, Melton LJ, et al (1998) Osteoporosis: review of the evidence for prevention, diagnosis, and treatment and cost-effectiveness analysis. Status report. Osteoporos Int 4:1–80Google Scholar
  5. 5.
    Smeets-Goevaers CG, Lesusink GL, Papapoulos SE, Maartens LW, Keyzer JJ, Weerdenburg JP, et al (1998) The prevalence of low bone mineral density in Dutch perimenopausal women: The Eindhoven perimenopausal osteoporosis study. Osteoporos Int 8:404–409PubMedGoogle Scholar
  6. 6.
    Bollen AM, Taguchi A, Hujoel PP, Hollender LG (2000) Case–control study on self-reported osteoporotic fractures and mandibular cortical bone. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90:518–524CrossRefPubMedGoogle Scholar
  7. 7.
    Kribbs PJ, Smith DE, Chesnut CH 3rd (1983) Oral findings in osteoporosis. Part II: Relationship between residual ridge and alveolar bone resorption and generalized skeletal osteopenia. J Prosthet Dent 50:719–724PubMedGoogle Scholar
  8. 8.
    Kribbs PJ, Chesnut CH 3rd (1994) Osteoporosis and dental osteopenia in the elderly. Gerodontology 3:101–106Google Scholar
  9. 9.
    Von Wowern N, Klausen B, Kollerup G (1994) Osteoporosis: a risk factor in periodontal disease. J Periodontol 65:1134–1138PubMedGoogle Scholar
  10. 10.
    Civitelli R, Pilgram TK, Dotson M, Muckerman J, Lewandowski N, Armamento-Villareal R, et al (2002) Alveolar and postcranial bone density in postmenopausal women receiving hormone/estrogen replacement therapy: a randomized, double-blind, placebo-controlled trial. Arch Intern Med 162:2634–2635PubMedGoogle Scholar
  11. 11.
    Klemetti E, Vainio P (1993) Effect of bone mineral density in skeleton and mandible on extraction of teeth and clinical alveolar height. J Prosthet Dent 70:21–25PubMedGoogle Scholar
  12. 12.
    Klemetti E, Collin HL, Forss H, Markkanen H, Lassila V (1994) Mineral status of skeleton and advanced periodontal disease. J Clin Periodontol 21:184–188PubMedGoogle Scholar
  13. 13.
    Taguchi A, Sanada M, Krall E, Nakamoto T, Ohtsuka M, Suei Y, Tanimoto K, Kodama I, Tsuda M, Ohama K (2003) Relationship between dental panoramic radiographic findings and biochemical markers of bone turnover. J Bone Miner Res 18:1689–1694PubMedGoogle Scholar
  14. 14.
    Ekman A, Michaelsson K, Petren-Mallmin M, Ljunghall S, Mallmin H (2001) DXA of the hip and heel ultrasound but not densitometry of the fingers can discriminate female hip fracture patients from controls: a comparison between four different methods. Osteoporos Int 12:185–191Google Scholar
  15. 15.
    Kirk JK, Nichols M, Spangler JG (2002) Use of a peripheral dexa measurement for osteoporosis screening Fam Med 34:201–205Google Scholar
  16. 16.
    Picard D, Brown JP, Rosenthall L, Couturier M, Levesque J, Dumont M, Ste-Marie LG, Tenenhouse A, Dodin S (2004) Ability of peripheral DXA measurement to diagnose osteoporosis as assessed by central DXA measurement. J Clin Densitom 7:111–118PubMedGoogle Scholar
  17. 17.
    Hudelmaier M, Kuhn V, Lochmuller EM, Well H, Priemel M, Link TM, Eckstein F (2004) Can geometry-based parameters from pQCT and material parameters from quantitative ultrasound (QUS) improve the prediction of radial bone strength over that by bone mass (DXA)? Osteoporos Int 15:375–381PubMedGoogle Scholar
  18. 18.
    Nakamoto T, Taguchi A, Ohtsuka M, Suei Y, Fujita M, Tanimoto K, Tsuda M, Sanada M, Ohama K, Takahashi J, Rohlin M (2003) Dental panoramic radiograph as a tool to detect postmenopausal women with low bone mineral density: untrained general dental practitioners’ diagnostic performance. Osteoporos Int 14:659–664PubMedGoogle Scholar
  19. 19.
    Wactawski-Wende J (2001) Periodontal diseases and osteoporosis: association and mechanisms Ann Periodontol 6:197–208Google Scholar
  20. 20.
    Chesnut CH 3rd (2001) The relationship between skeletal and oral bone mineral density: an overview Ann Periodontol 6:193–196Google Scholar
  21. 21.
    Payne JB, Reinhardt RA, Nummikoski PV, Patil KD (1999) Longitudinal alveolar bone loss in postmenopausal osteoporotic/osteopenic women. Osteoporos Int 10:34–40PubMedGoogle Scholar
  22. 22.
    Tezal M, Wactawski-Wende J, Grossi SG, Ho AW, Dunford R, Genco RJ (2000) The relationship between bone mineral density and periodontitis in postmenopausal women. J Periodontol 71:1492–1498PubMedGoogle Scholar
  23. 23.
    Inagaki K, Kurosu Y, Kamiya T, Kondo F, Yoshinari N, Noguchi T, Krall EA, Garcia RI (2001) Low metacarpal bone density, tooth loss, and periodontal disease in Japanese women. J Dent Res 80:1818–1822PubMedGoogle Scholar
  24. 24.
    Persson RE, Hollender LG, Powell LV, MacEntee MI, Wyatt CC, Kiyak HA, Persson GR, et al (2002) Assessment of periodontal conditions and systemic disease in older subjects: Focus on osteoporosis. J Clin Periodontol 29:796–802PubMedGoogle Scholar
  25. 25.
    Mager DL, Ximenez-Fyvie LA, Haffajee AD, Socransky SS (2003) Distribution of selected bacterial species on intraoral surfaces. J Clin Periodontol 30:644–654Google Scholar
  26. 26.
    Page RC, Offenbacher S, Schroeder HE, Seymour GJ, Kornman KS (1997) Advances in the pathogenesis of periodontitis: summary of developments, clinical implications and future directions. Periodontol 14:216–248Google Scholar
  27. 27.
    Sun JL, Meng HX, Cao CF, Tachi Y, Shinohara M, Ueda M, Imai H, Ohura K (2002) Relationship between vitamin D receptor gene polymorphism and periodontitis. J Periodontal Res 37:263–267PubMedGoogle Scholar
  28. 28.
    Chevalley T, Rizzoli R, Nydegger V, Slosman D, Rapin CH, Michel JP, et al (1994) Effects of calcium supplements on femoral bone mineral density and vertebral fracture rate in vitamin D–replete elderly patients. Osteoporos Int 4:245–252PubMedGoogle Scholar
  29. 29.
    Dawson-Hughes B, Harris SS, Krall EA, Dallal GE (1997) Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 337:670–676CrossRefPubMedGoogle Scholar
  30. 30.
    Persson RE, Persson GR, Kiyak HA, Powell LV (1998) Oral health and medical status in dentate low-income older persons. Spec Care Dent 18:70–77Google Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2004

Authors and Affiliations

  • Anders Halling
    • 1
  • G. Rutger Persson
    • 2
    • 3
  • Johan Berglund
    • 1
    • 4
  • Owe Johansson
    • 5
  • Stefan Renvert
    • 6
  1. 1.Blekinge Institute for Research and DevelopmentKarlshamnSweden
  2. 2.Department of Periodontics and Fixed ProsthodonticsUniversity of BernBernSwitzerland
  3. 3.Department of PeriodontologyUniversity of WashingtonSeattleUSA
  4. 4.Department of Community MedicineLund UniversityMalmöSweden
  5. 5.Department of PeriodontologyPublic Dental ServicesKarlskronaSweden
  6. 6.Department of Health SciencesKristianstad UniversityKristianstadSweden

Personalised recommendations