Clinical Oral Investigations

, Volume 17, Issue 6, pp 1611–1617 | Cite as

Correlation between hand/wrist and panoramic radiographs in severe secondary hyperparathyroidism

  • João César Guimarães Henriques
  • Julio Cezar de Melo Castilho
  • Reinhilde Jacobs
  • José Benedito Oliveira Amorim
  • Rafaela Rangel Rosa
  • Caio Vinícius Bardi Matai
Original Article



Hand/wrist and dental radiographs are important for osteoporosis analysis in secondary hyperparathyroidism (SHPT). This study evaluated whether a correlation exists between the effects of the disease on the hands and jaws, and investigated the association between osteoporosis progression in the hands and parathyroid hormone (PTH) levels in chronic kidney disease (CKD) patients.

Materials and methods

Four panoramic radiographic parameters (mental index, mandibular cortical index, trabecular bone pattern, and calcification/resorption) and four corresponding hand/wrist radiographic parameters (metacarpal cortical thickness, phalangeal cortical index, trabecular bone pattern, and calcification/resorption) were applied to investigate possible correlation between the effects of SHPT on the jaws and hands/wrists, by Spearman's correlation coefficient. PTH levels and the hand/wrist radiographic parameters were also tested by spearman's correlation coefficient (p < 0.05). The presence of brown tumors, vascular calcifications, and acroosteolysis on the hands was also evaluated.


Mandibular cortical index was strongly correlated with the phalangeal cortical index (p = 0.000). Phalangeal cortical index and trabecular bone pattern of hand/wrist correlated with PTH levels (0.002 and 0.000, respectively). Brown tumors occurred in four CKD patients, while both vascular calcifications and acroosteolysis were observed in 19 patients.


There is a significant correlation between the morphological changes caused by secondary hyperparathyroidism in hand and jaw bones. The morphological status can be assessed using the mandibular cortical index, besides the phalangeal cortical index. The latter correlates well with parathyroid hormone levels of advanced chronic kidney disease.

Clinical relevance

Panoramic images reveal morphological changes in the jaw bone, indicating likewise changes in the hand/wrist in severe secondary hyperparathyroidism. The severity of the bone changes may be a reflection of the parathyroid hormone levels in advanced chronic kidney disease.


Secondary hyperparathyroidism Carpal bones Hand Panoramic radiography Parathyroid hormone Kidney diseases 


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • João César Guimarães Henriques
    • 1
    • 4
  • Julio Cezar de Melo Castilho
    • 1
  • Reinhilde Jacobs
    • 2
  • José Benedito Oliveira Amorim
    • 3
  • Rafaela Rangel Rosa
    • 1
  • Caio Vinícius Bardi Matai
    • 1
  1. 1.Department of Diagnosis and Surgery, School of DentistryUNESP—Univ Estadual PaulistaSão PauloBrazil
  2. 2.Oral Imaging Center, School of DentistryOral Pathology and Maxillofacial SurgeryLeuvenBelgium
  3. 3.Department of Oral Diagnosis and Bioscience, School of DentistryUNESP—Univ Estadual PaulistaSão PauloBrazil
  4. 4.Disciplina de Radiologia Odontológica da Faculdade de OdontologiaUniversidade Estadual Paulista “Júlio de Mesquita Filho”São PauloBrazil

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