Osteoporosis International

, Volume 17, Issue 3, pp 387–394 | Cite as

Use of dental panoramic radiographs in identifying younger postmenopausal women with osteoporosis

  • Akira TaguchiEmail author
  • Mikio Tsuda
  • Masahiko Ohtsuka
  • Ichiro Kodama
  • Mitsuhiro Sanada
  • Takashi Nakamoto
  • Koji Inagaki
  • Toshihide Noguchi
  • Yoshiki Kudo
  • Yoshikazu Suei
  • Keiji Tanimoto
  • Anne-Marie Bollen
Original Article


Introduction: Eroded or thin inferior cortex of the mandible detected on dental panoramic radiographs may be useful for identifying postmenopausal women with low bone mineral density (BMD) or osteoporosis. The purpose of this study was to evaluate whether these panoramic measurements are useful for identifying low BMD or osteoporosis in postmenopausal women younger than 65 years. Methods: We compared the diagnostic performances of panoramic measurements with those of the osteoporosis self-assessment tool (OST) for identifying women with low BMD (T-score of −2.0 or less at either the lumbar spine or the femoral neck) and osteoporosis (T score of −2.5 or less) in 158 healthy Japanese postmenopausal women aged 46 years to 64 years. Mandibular cortical shape (erosion) and width were evaluated on dental panoramic radiographs. Receiver operating characteristic curve analysis was used to determine the optimal cutoff thresholds for cortical width and OST index. Results: The sensitivity and specificity, respectively, for identifying women with low BMD were 82.3% and 55.2% for OST index, 79.0% and 50.0% for cortical width, and 72.6% and 74.0% for cortical shape. The sensitivity and specificity, respectively, for identifying women with osteoporosis were 86.7% and 46.9% for OST index, 90.0% and 45.3% for cortical width, and 86.7% and 65.6% for cortical shape. Likelihood ratio for identifying women with low BMD was 13.90 for thin cortical width (<3.0 mm) and 10.84 for severely eroded cortex. That for identifying women with osteoporosis was 6.40 for thin cortical width and 7.11 for severely eroded cortex. Conclusions: Dentists may be able to refer postmenopausal women younger than 65 years for bone densitometry on the basis of incidental findings on dental panoramic radiographs.


Dentist Menopause Osteoporosis Radiographs Screening 



This study was supported by a grant-in-aid for scientific research from the Japan Society for the Promotion of Science (14571786, 16390616).


  1. 1.
    Bone health and osteoporosis: a surgeon general’s report. (2004)
  2. 2.
    Kanis JA, Johnell O (2005) Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int 16:229–238PubMedCrossRefGoogle Scholar
  3. 3.
    Koh LK, Sedrine WB, Torralba TP, Kung A, Fujiwara S, Chan SP, et al (2001) A simple tool to identify Asian women at increased risk of osteoporosis. Osteoporos Int 12:699–705PubMedCrossRefGoogle Scholar
  4. 4.
    Cadarette SM, Jaglal SB, Murray TM, McIsaac WJ, Joseph L, Brown JP, Canadian Multicentre Osteoporosis Study (2001) Evaluation of decision rules for referring women for bone densitometry by dual-energy X-ray absorptiometry. JAMA 286:57–63PubMedCrossRefGoogle Scholar
  5. 5.
    Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA, Tu JV (2000) Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ 162:1289–1294PubMedGoogle Scholar
  6. 6.
    Shimano T, Suzuki Y, Sasaki T (2002) Long-term trend of dental radiographic examination in Japan—analysis on health insurance data (in Japanese). Dent Radiol 42:9–21Google Scholar
  7. 7.
    Klemetti E, Kolmakov S, Kroger H (1994) Pantomography in assessment of the osteoporosis risk group. Scand J Dent Res 102:68–72PubMedGoogle Scholar
  8. 8.
    Taguchi A, Suei Y, Ohtsuka M, Otani K, Tanimoto K, Ohtaki M (1996) Usefulness of panoramic radiography in the diagnosis of postmenopausal osteoporosis in women. Width and morphology of inferior cortex of the mandible. Dentomaxillofac Radiol 25:263–267PubMedGoogle Scholar
  9. 9.
    Nakamoto T, Taguchi A, Ohtsuka M, Suei Y, Fujita M, Tanimoto K, et al (2003) Dental panoramic radiograph as a tool to detect postmenopausal women with low bone mineral density: untrained general dental practitioners’ diagnostic performance. Osteoporos Int 14:659–664PubMedCrossRefGoogle Scholar
  10. 10.
    Taguchi A, Sanada M, Krall E, Nakamoto T, Ohtsuka M, Suei Y, et al (2003) Relationship between dental panoramic radiographic findings and biochemical markers of bone turnover. J Bone Miner Res 18:1689–1694PubMedCrossRefGoogle Scholar
  11. 11.
    Taguchi A, Suei Y, Sanada M, Ohtsuka M, Nakamoto T, Sumida H, et al (2004) Validation of dental panoramic radiography measures for identifying postmenopausal women with spinal osteoporosis. AJR Am J Roentgenol 183:1755–1760PubMedGoogle Scholar
  12. 12.
    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 90:518–524PubMedCrossRefGoogle Scholar
  13. 13.
    Persson RE, Hollender LG, Powell LV, MacEntee MI, Wyatt CC, Kiyak HA, et al (2002) Assessment of periodontal conditions and systemic disease in older subjects. I. Focus on osteoporosis. J Clin Periodontol 29:796–802PubMedCrossRefGoogle Scholar
  14. 14.
    White SC, Taguchi A, Kao D, Wu S, Service SK, Yoon D, et al (2005) Clinical and panoramic predictors of femur bone mineral density. Osteoporos Int 16:339–346PubMedCrossRefGoogle Scholar
  15. 15.
    Devlin H, Horner K (2002) Mandibular radiomorphometric indices in the diagnosis of reduced skeletal bone mineral density. Osteoporos Int 13:373–378CrossRefPubMedGoogle Scholar
  16. 16.
    Horner K, Devlin H, Harvey L (2002) Detecting patients with low skeletal bone mass. J Dent 30:171–175CrossRefPubMedGoogle Scholar
  17. 17.
    Drozdzowska B, Pluskiewicz W, Tarnawska B (2002) Panoramic-based mandibular indices in relation to mandibular bone mineral density and skeletal status assessed by dual energy X-ray absorptiometry and quantitative ultrasound. Dentomaxillofac Radiol 31:361–367CrossRefPubMedGoogle Scholar
  18. 18.
    Halling A, Persson GR, Berglund J, Johansson O, Renvert S (2005) Comparison between the Klemetti index and heel DXA BMD measurements in the diagnosis of reduced skeletal bone mineral density in the elderly. Osteoporos Int 16:999-1003CrossRefPubMedGoogle Scholar
  19. 19.
    Geusens P, Hochberg MC, van der Voort DJ, Pols H, van der Klift M, Siris E, et al (2002) Performance of risk indices for identifying low bone density in postmenopausal women. Mayo Clin Proc 77:629–637PubMedGoogle Scholar
  20. 20.
    Cadarette SM, McIsaac WJ, Hawker GA, Jaakkimainen L, Culbert A, Zarifa G, et al (2004) The validity of decision rules for selecting women with primary osteoporosis for bone mineral density testing. Osteoporos Int 15:361–366CrossRefPubMedGoogle Scholar
  21. 21.
    Mauck KF, Cuddihy MT, Atkinson EJ, Melton LJ 3rd (2005) Use of clinical prediction rules in detecting osteoporosis in a population-based sample of postmenopausal women. Arch Intern Med 165:530–536CrossRefPubMedGoogle Scholar
  22. 22.
    Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148PubMedCrossRefGoogle Scholar
  23. 23.
    National Osteoporosis Foundation (1998) Physician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington, DCGoogle Scholar
  24. 24.
    Simel DL, Samsa GP, Matchar DB (1991) Likelihood ratios with confidence: sample size estimation for diagnostic test studies. J Clin Epidemiol 44:763–770CrossRefPubMedGoogle Scholar
  25. 25.
    Cohen J (1960) A coefficient of agreement for nominal scales. Educ Psychol Meas 20:37–46CrossRefGoogle Scholar
  26. 26.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRefGoogle Scholar
  27. 27.
    Richy F, Gourlay M, Ross PD, Sen SS, Radican L, De Ceulaer F, et al (2004) Validation and comparative evaluation of the osteoporosis self-assessment tool (OST) in a Caucasian population from Belgium. QJM 97:39–46CrossRefPubMedGoogle Scholar
  28. 28.
    Lee K, Taguchi A, Ishii K, Suei Y, Fujita M, Nakamoto T, et al (2005) Visual estimation of mandibular cortex on panoramic radiographs in identifying postmenopausal women with low bone mineral densities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 100:226-231CrossRefPubMedGoogle Scholar
  29. 29.
    Arifin AZ, Asano A, Taguchi A, Nakamoto T, Ohtsuka M, Tanimoto K (2005) Computer-aided system for measuring the mandibular cortical width on panoramic radiographs in osteoporosis diagnosis. Proc SPIE Med Imaging 2005—Image Processing Conference; Proc SPIE 5747: 813-821Google Scholar
  30. 30.
    Iki M, Kagamimori S, Kagawa Y, Matsuzaki T, Yoneshima H, Marumo F (2001) Bone mineral density of the spine, hip and distal forearm in representative samples of the Japanese female population: Japanese Population-Based Osteoporosis (JPOS) Study. Osteoporos Int 12:529–537PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005

Authors and Affiliations

  • Akira Taguchi
    • 1
    Email author
  • Mikio Tsuda
    • 2
  • Masahiko Ohtsuka
    • 3
  • Ichiro Kodama
    • 2
  • Mitsuhiro Sanada
    • 2
  • Takashi Nakamoto
    • 1
  • Koji Inagaki
    • 4
  • Toshihide Noguchi
    • 4
  • Yoshiki Kudo
    • 2
  • Yoshikazu Suei
    • 1
  • Keiji Tanimoto
    • 3
  • Anne-Marie Bollen
    • 5
  1. 1.Department of Oral and Maxillofacial RadiologyHiroshima University HospitalHiroshimaJapan
  2. 2.Department of Obstetrics and Gynecology, Division of Clinical Medical Science, Graduate School of Biomedical SciencesHiroshima UniversityHiroshimaJapan
  3. 3.Department of Oral and Maxillofacial Radiology, Division of Medical Intelligence and Informatics, Graduate School of Biomedical SciencesHiroshima UniversityHiroshimaJapan
  4. 4.Department of Periodontology, School of DentistryAichi-Gakuin UniversityNagoyaJapan
  5. 5.Department of Orthodontics, School of DentistryUniversity of WashingtonUSA

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