title: Observer performance in diagnosing osteoporosis by dental panoramic radiographs: results from the osteoporosis screening project in dentistry (OSPD).
abstract: Mandibular cortical erosion detected on dental panoramic radiographs (DPRs) may be useful for identifying women with osteoporosis, but little is known about the variation in diagnostic efficacy of observers worldwide. The purpose of this study was to measure the accuracy in identifying women at risk for osteoporosis in a worldwide group of observers using DPRs. We constructed a website that included background information about osteoporosis screening and instructions regarding the interpretation of mandibular cortical erosion. DPRs of 100 Japanese postmenopausal women aged 50 years or older who had completed skeletal bone mineral measurements by dual energy X-ray absorptiometry were digitized at 300 dpi. These were displayed on the website and used for the evaluation of diagnostic efficacy. Sixty observers aged 25 to 66 years recruited from 16 countries participated in this study. These observers classified cortical erosion into one of three groups (none, mild to moderate, and severe) on the website via the Internet, twice with an approximately 2-week interval. The diagnostic efficacy of the Osteoporosis Self-Assessment Tool (OST), a simple clinical decision rule based on age and weight, was also calculated and compared with that of cortical erosion. The overall mean sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the 60 observers in identifying women with osteoporosis by cortical erosion on DPRs were 82.5, 46.2, 46.7, and 84.0%, respectively. Those same values by the OST index were 82.9, 43.1, 43.9, and 82.4%, respectively. The intra-observer agreement in classifying cortical erosion on DPRs was sufficient (weighted kappa values>0.6) in 36 (60%) observers. This was significantly increased in observers who specialized in oral radiology (P<0.05). In the 36 observers with sufficient intra-observer agreement, the overall mean sensitivity, specificity, PPV, and NPV in identifying women with osteoporosis by any cortical erosion were 83.5, 48.7, 48.3, and 85.7%, respectively. The mean PPV and NPV were significantly higher in the 36 observers with sufficient intra-observer agreement than in the 24 observers with insufficient intra-observer agreement. Our results reconfirm the efficacy of cortical erosion findings in identifying postmenopausal women at risk for osteoporosis, among observers with sufficient intra-observer agreement. Information gathered from radiographic examination is at least as useful as that gathered from the OST index.
authors.affiliation: Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, Hiroshima, Japan. Electronic address: akiro@hiroshima-u.ac.jp.
authors.forename: A
authors.initials: A
authors.lastname: Taguchi
authors.affiliation: Division of Mathematical and Information Sciences, Faculty of Integrated Arts and Sciences, Hiroshima University, Higashi-Hiroshima, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Asano
authors.affiliation: Department of Oral and Maxillofacial Radiology, Division of Medical Intelligence and Informatics, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Ohtsuka
authors.affiliation: Department of Oral and Maxillofacial Radiology, Division of Medical Intelligence and Informatics, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nakamoto
authors.affiliation: Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Suei
authors.affiliation: Department of Obstetrics and Gynecology, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Tsuda
authors.affiliation: Department of Obstetrics and Gynecology, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kudo
authors.affiliation: Department of Periodontology, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Inagaki
authors.affiliation: Department of Periodontology, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Noguchi
authors.affiliation: Department of Oral and Maxillofacial Radiology, Division of Medical Intelligence and Informatics, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Tanimoto
authors.affiliation: Oral Imaging Centre, School of Dentistry, Oral Pathology and Maxillofacial Surgery, Catholic University Leuven, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Jacobs
authors.affiliation: Department of Prosthetic Dentistry and Stomatognathic Physiology, University of Tromsø, Norway.
authors.forename: E
authors.initials: E
authors.lastname: Klemetti
authors.affiliation: Section of Oral and Maxillofacial Radiology, UCLA School of Dentistry, Los Angeles, USA.
authors.forename: S C
authors.initials: SC
authors.lastname: White
authors.affiliation: Unit of Oral Radiology, University Dental Hospital of Manchester, Manchester, UK.
authors.forename: K
authors.initials: K
authors.lastname: Horner
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D003752:Dental Health Services; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging*; D017698:Postmenopause; D011862:Radiography, Panoramic