title: Dental panoramic radiograph as a tool to detect postmenopausal women with low bone mineral density: untrained general dental practitioners' diagnostic performance.
abstract: The detection of postmenopausal women with low bone mineral density (BMD) is an important strategy to reduce the incidence of osteoporotic fracture. Recent studies suggested that incidental findings on dental panoramic radiographs may be used as a tool to detect women with low BMD. However, little is known whether this finding is sufficiently assessed by untrained general dental practitioners (GDPs). The purpose of this study was to investigate: (1) the observer agreement and (2) the diagnostic efficacy in detecting women with low BMD, when untrained GDPs assess the appearance (normal or eroded) of the mandibular inferior cortex on dental panoramic radiographs of postmenopausal women. Twenty-seven GDPs were asked to classify the appearance of the mandibular inferior cortex on dental panoramic radiographs of 100 postmenopausal women who had completed BMD assessments of the lumbar spine and of the femoral neck. Intra-and inter-observer agreements were analyzed with kappa statistics. The diagnostic efficacy (sensitivity, specificity and predictive values) was analyzed by comparing two groups classified by the mandibular inferior cortex (women with normal and women with eroded mandibular inferior cortex) with those classified by BMD (women with normal BMD and women with osteopenia or osteoporosis). The mean sensitivity and specificity were 77% and 40%, respectively, when BMD of the lumbar spine was used as standard and 75% and 39%, respectively, when BMD of the femoral neck comprised the standard. Nineteen untrained GDPs (70%) presented a moderate to almost perfect intra-observer agreement. We conclude that dental panoramic radiograph may be used in clinical dental practice to identify postmenopausal women who have undetected low BMD and should undergo further testing with bone densitometry.
authors.affiliation: Department of Oral and Maxillofacial Radiology, Division of Medical Intelligence and Informatics, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakamoto
authors.forename: Akira
authors.initials: A
authors.lastname: Taguchi
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ohtsuka
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Suei
authors.forename: Minoru
authors.initials: M
authors.lastname: Fujita
authors.forename: Keiji
authors.initials: K
authors.lastname: Tanimoto
authors.forename: Mikio
authors.initials: M
authors.lastname: Tsuda
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Sanada
authors.forename: Koso
authors.initials: K
authors.lastname: Ohama
authors.forename: Junichiro
authors.initials: J
authors.lastname: Takahashi
authors.forename: Madeleine
authors.initials: M
authors.lastname: Rohlin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D002983:Clinical Competence; D003813:Dentistry; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D006801:Humans; D033162:Incidental Findings; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008334:Mandible / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D015588:Observer Variation; D015663:Osteoporosis, Postmenopausal / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011862:Radiography, Panoramic; D012680:Sensitivity and Specificity