Clinical and panoramic predictors of femur bone mineral density.
Dentists are a potentially valuable resource for initial patient screening for signs of osteoporosis, as individuals with osteoporosis have altered architecture of the inferior border of the mandible as seen on panoramic radiographs. Our aim was to evaluate the efficacy of combining clinical and dental panoramic radiographic risk factors for identifying individuals with low femoral bone mass. Bone mineral density was measured at the femoral neck and classified as normal, osteopenic or osteoporotic using WHO criteria in 227 Japanese postmenopausal women (33-84 years). Panoramic radiographs were made of all subjects. Mandibular cortical shape and width was determined and trabecular features were measured in each ramus. Mean subject age, height, and weight were significantly different in the three bone-density groups (P<0.0001). A classification and regression trees (CART) analysis using just clinical risk factors identified 136 (87%) of the 157 individuals with femoral osteopenia or osteoporosis. Mean mandible cortical width (P<0.0001), cortical index (P<0.0001) and trabecular features (P=0.02) were also significantly different in the three bone density groups. A CART analysis considering only radiographic features found 130 (83%) of the 157 individuals with femoral osteopenia or osteoporosis, although none of the subjects with osteoporosis was correctly identified. A CART analysis using both clinical and radiographic features found that the most useful risk factors were thickness of inferior border of the mandible and age. This algorithm identified 130 (83%) of the 157 individuals with femoral osteopenia or osteoporosis. The results of this study suggest that 1) clinical information is as useful as panoramic radiographic information for identifying subjects having low bone mass, and 2) dentists have sufficient clinical and radiographic information to play a useful role in screening for individuals with osteoporosis.
White
Stuart C
SC
Section of Oral and Maxillofacial Radiology, UCLA School of Dentistry, 10833 Le Conte Avenue, Los Angeles, CA 90095-1668, USA. swhite@ucla.edu
Taguchi
Akira
A
Kao
David
D
Wu
Sam
S
Service
Susan K
SK
Yoon
Douglas
D
Suei
Yoshikazu
Y
Nakamoto
Takashi
T
Tanimoto
Keiji
K
D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000704:Analysis of Variance; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging; D003815:Dentists; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D006801:Humans; D008334:Mandible / Q000000981:diagnostic imaging*; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis / Q000000981:diagnostic imaging*; D018570:Risk Assessment; D012307:Risk Factors
Osteoporos Int. 2001;12(7):519-28
11527048
Scand J Dent Res. 1994 Feb;102(1):68-72
8153584
J Bone Miner Res. 1996 Jul;11(7):955-61
8797116
Radiology. 1993 Feb;186(2):471-4
8421753
J Prosthet Dent. 1989 Dec;62(6):703-7
2585328
J Prosthet Dent. 1990 Jan;63(1):86-9
2295992
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995 Nov;80(5):612-6
8556469
Microsc Res Tech. 1999 May 15-Jun 1;45(4-5):303-12
10383123
Epidemiol Rev. 1985;7:178-208
3902494
Dentomaxillofac Radiol. 1996 Nov;25(5):263-7
9161180
J Bone Miner Res. 1990 Mar;5(3):227-33
2333781
Dentomaxillofac Radiol. 1999 May;28(3):173-81
10740473
Bone. 1996 Mar;18(3 Suppl):149S-157S
8777081
Bone. 1999 Sep;25(3):369-74
10495142
Oral Surg Oral Med Oral Pathol. 1992 Jan;73(1):112-7
1603549
Osteoporos Int. 2002 May;13(5):373-8
12086347
Arch Intern Med. 1996 Jul 22;156(14):1521-5
8687260
J Bone Miner Res. 1994 May;9(5):671-7
8053396
Osteoporos Int. 2002 Jul;13(7):593-9
12111021
J Bone Miner Res. 1997 Jan;12(1):111-8
9240733
Gynecol Endocrinol. 2002 Jun;16(3):245-50
12192897
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 Oct;90(4):518-24
11027391
Clin Orthop Relat Res. 1987 Feb;(215):260-71
3802645
Am J Manag Care. 1998 Jan;4(1):37-48
10179905
Arch Orthop Trauma Surg. 1996;115(5):262-9
8836458
J Microsc. 1986 Jun;142(Pt 3):341-9
3735417
Osteoporos Int. 1999;9(5):410-9
10550460
J Dent. 1998 May;26(4):337-43
9611939
J Am Dent Assoc. 1996 Dec;127(12 ):1734-42
8990743
N Engl J Med. 1995 Mar 23;332(12):767-73
7862179
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999 Nov;88(5):628-35
10556761
Dentomaxillofac Radiol. 2002 Mar;31(2):84-92
12076061
Oral Surg Oral Med Oral Pathol. 1993 Jun;75(6):774-9
8515993
CMAJ. 2000 May 2;162(9):1289-94
10813010
Osteoporos Int. 2001;12(8):699-705
11580084
Acad Radiol. 1997 Mar;4(3):167-76
9084773
Osteoporos Int. 2002 Jan;13(1):6-17
11878456
J Bone Miner Res. 2001 Aug;16(8):1520-31
11499875