Oral Radiology

, Volume 34, Issue 2, pp 172–178 | Cite as

Evaluation of renal osteodystrophy in the dental clinic by assessment of mandibular and phalangeal cortical indices

  • Bruna Corrêa Massahud
  • João César Guimarães Henriques
  • Reinhilde Jacobs
  • Rafaela Rangel Rosa
  • Caio Vinícius Bardi Matai
Original Article



Secondary hyperparathyroidism (SHPT) is a disease that affects patients with chronic kidney disease, and is characterized by mineral disturbance and bone loss, known as renal osteodystrophy. The aim of this study was to assess the validity of using intraoral phosphor storage plates to take radiographs of the middle phalanges to evaluate bone loss resulting from SHPT during follow-up of these patients.


The sample consisted of 24 patients with chronic kidney disease, 12 with parathyroid hormone (PTH) levels ≥500 pg/ml, and 12 with PTH levels <500 pg/ml, who underwent hemodialysis weekly. For each patient, a panoramic radiograph and digital radiographs of the ring, index, and middle fingers of both hands were taken. The Mandibular Cortical Index (MCI) and the Trabecular Bone Pattern Index (TBP) were applied to the panoramic radiographs, while the Phalangeal Cortical Index (PCI) was applied to the digital radiographs of the phalanges. Three evaluators performed all analyses.


Significant correlations were found between the PTH levels and the MCI (p = 0.023), the PCI (p = 0.039) and the TBP index (p = 0.032). These parameters were also significantly interrelated (MCI × PCI = 0.001; MCI × TBP = 0.004 and PCI × TBP = 0.009). The PCI was shown to have the highest correlation with PTH levels.


In patients with chronic renal disease, it is clinically relevant to use panoramic and digital radiographs using intraoral storage plates to assess a number of quantitative parameters that can be linked to PTH levels.


Chronic kidney disease Secondary hyperparathyroidism Renal osteodystrophy Dental radiography Phalanges of the fingers 



This research was conducted with financial assistance from the Research Support Foundation of the State of Minas Gerais—FAPEMIG.

Compliance with ethical standards

Conflict of interest

Authors Bruna Corrêa Massahud, João César Guimarães Henriques, Reinhilde Jacobs, Rafaela Rangel Rosa and Caio Vinícius Bardi Matai declare that they have no conflict of interest.

Human rights statements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Informed consent was obtained from all patients for being included in the study.

Animal rights statement

This article does not contain any studies with animal subjects performed by any of the authors.


  1. 1.
    Hansen D, Brandi L, Rasmussen K. Treatment of secondary hyperparathyroidism in haemodialysis patients: a randomized clinical trial comparing paricalcitol and alfacalcidol. BMC Nephrol. 2009;10:28.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Moe SM, Drueke TB, Block GA, Cannata-Andía JB, Elder GJ, Fukagawa M, et al. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorder (CKD–MBD). Kidney Int Suppl. 2009;113:S1–130.Google Scholar
  3. 3.
    Koizumi M, Komaba H, Nakanishi S, Fujimori A, Fukagawa M. Cincalcet treatment and serum FGF23 levels in haemodialysis patients with secondary hyperparathyroidism. Nephrol Dial Transplant. 2009;27:790–5.Google Scholar
  4. 4.
    Noleto JW, Ramos IA, Rocha JF, Garcia IR Jr, Salvador Roberto BM. A rare case of regression of brown tumors of tertiary hyperparathyroidism after parathyroidectomy and renal transplant: a 5-year follow-up. Ann Maxillofac Surg. 2016;6:125–9.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Lacativa PG, Franco FM, Pimentel JR, Patrício Filho PJ, Gonçalves MD, Farias ML. Prevalence of radiological findings among cases of severe secondary hyperparathyroidism. São Paulo Med J. 2009;127:71–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Ward KA, Cotton J, Adams JE. A technical and clinical evaluation of digital X-ray radiogrammetry. Osteoporos Int. 2009;14:389–95.CrossRefGoogle Scholar
  7. 7.
    Henriques JC, Castilho JC, Jacobs R, Amorim JB, Rosa RR, Matai CV. Correlation between hand/wrist and panoramic radiographs in severe secondary hyperparathyroidism. Clin Oral Invest. 2012;17:1611–7.CrossRefGoogle Scholar
  8. 8.
    Henriques JC, de Melo Castilho JC, Jacobs R, Amorim JB, Rosa RR, Matai CV. Severe secondary hyperparathyroidism and panoramic radiography parameters. Clin Oral Investig. 2014;18:941–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Cardoso FN, Yanaguizawa M, Taberner GS, Kubota ES, Fernandes ARC, Natour J. Radiology contribution for the evaluation of secondary hyperparathyroidism. Rev Bras Reumatol. 2007;47:207–11.CrossRefGoogle Scholar
  10. 10.
    Lindh C, Petersson A, Rohlin M. Assessment of the trabecular pattern before endosseous implant treatment. Oral Surg Oral Med Oral Pathol Radiol Endod. 1996;82:335–43.CrossRefGoogle Scholar
  11. 11.
    Lindh C, Horner K, Jonasson G, Olsson P, Rohlin M, Jacobs R, et al. The use of visual assessment of dental radiographs for identifying women at risk of having osteoporosis: the OSTEODENT project. Oral Surg Oral Med Oral Pathol. 2008;106:285–93.CrossRefGoogle Scholar
  12. 12.
    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;75:774–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Tomiyama C, Carvalho AB, Higa A, Jorgetti V, Draibe SA, Canziani ME. Coronary calcification is associated with lower bone formation rate in CKD patients not yet in dialysis treatment. J Bone Miner Res. 2010;25:499–504.CrossRefPubMedGoogle Scholar
  14. 14.
    Leite AF, Figueiredo PT, Guia CM, Melo NS, Paula AP. Correlations between seven panoramic radiomorphometric indices and bone mineral density in postmenopausal women. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109:449–56.CrossRefPubMedGoogle Scholar
  15. 15.
    Antonelli JR, Hottel TL. Oral manifestations of renal osteodystrophy: case report and review of the literature. Spec Care Dent. 2003;23:28–34.CrossRefGoogle Scholar
  16. 16.
    Ketteler M, Biggar PH. Getting the balance right: assessing causes and extent of vascular calcification in chronic kidney disease. Nephrology. 2009;14:389–94.CrossRefPubMedGoogle Scholar
  17. 17.
    Gulsahi A, Ozden S, Cebeci AI, Kucuk NO, Paksoy CS, Genc Y. The relationship between panoramic radiomorphometric indices and the femoral bone mineral density of edentulous patients. Oral Radiol. 2009;25:47–52.CrossRefGoogle Scholar
  18. 18.
    Marinho SM, Wahrlich V, Mafra D. Association between body composition and bone mineral density in men on hemodialysis. Am J Med Sci. 2015;350:286–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Benmoussa L, Renoux M, Radoï L. Oral manifestations of chronic renal failure complicating a systemic genetic disease: diagnostic dilemma. Case report and literature review. J Oral Maxillofac Surg. 2015;73:2142–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Jacobs R, Ghyselen J, Koninckx P, van Steenberghe D. Long-term bone mass evaluation of mandible and lumbar spine in a group of women receiving hormone replacement therapy. Eur J Oral Sci. 1996;104:10–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Kathirvelu D, Anburajan M. Prediction of low bone mass using a combinational approach of cortical and trabecular bone measures from dental panoramic radiographs. Proc Inst Mech Eng H. 2014;228:890–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Wei Y, Lin J, Yang F, Li X, Hou Y, Lu R, et al. Risk factors associated with secondary hyperparathyroidism in patients with chronic kidney disease. Exp Ther Med. 2016;12:1206–12.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Hussain M, Hammam M. Management challenges with brown tumor of primary hyperparathyroidism masked by severe vitamin D deficiency: a case report. Med Case Rep. 2016;10:166.CrossRefGoogle Scholar
  24. 24.
    Foster JD. Update on mineral and bone disorders in chronic kidney disease. Vet Clin North Am Small Anim Pract. 2016;46:1131–49.CrossRefPubMedGoogle Scholar
  25. 25.
    Yuen NK, Ananthakrishnan S, Campbell MJ. Hyperparathyroidism of renal disease. Perm J. 2016;20:78–83.PubMedPubMedCentralGoogle Scholar

Copyright information

© Japanese Society for Oral and Maxillofacial Radiology and Springer Japan KK 2017

Authors and Affiliations

  • Bruna Corrêa Massahud
    • 1
  • João César Guimarães Henriques
    • 1
  • Reinhilde Jacobs
    • 2
  • Rafaela Rangel Rosa
    • 3
  • Caio Vinícius Bardi Matai
    • 3
  1. 1.Diagnosis and Stomatology DepartmentUniversidade Federal de UberlândiaUberlândiaBrazil
  2. 2.Oral Imaging CenterKatholieke Universiteit LeuvenLouvainBelgium
  3. 3.Faculdade de Odontologia, Campus de São José dos CamposUniversidade Estadual Paulista Julio de Mesquita FilhoSão PauloBrazil

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