title: Correlation between hand/wrist and panoramic radiographs in severe secondary hyperparathyroidism.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Diagnosis and Surgery, School of Dentistry, UNESP-Univ Estadual Paulista, São José dos Campos, São Paulo, Brazil. joaocesarhenriques@yahoo.com.br
authors.forename: João César Guimarães
authors.initials: JC
authors.lastname: Henriques
authors.forename: Julio Cezar de Melo
authors.initials: JC
authors.lastname: Castilho
authors.forename: Reinhilde
authors.initials: R
authors.lastname: Jacobs
authors.forename: José Benedito Oliveira
authors.initials: JB
authors.lastname: Amorim
authors.forename: Rafaela Rangel
authors.initials: RR
authors.lastname: Rosa
authors.forename: Caio Vinícius Bardi
authors.initials: CV
authors.lastname: Matai
mesh_terms: D030981:Acro-Osteolysis / Q000000981:diagnostic imaging; D001862:Bone Resorption / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000000981:diagnostic imaging; D002348:Carpal Bones / Q000000981:diagnostic imaging*; D018450:Disease Progression; D050278:Finger Phalanges / Q000000981:diagnostic imaging; D006101:Granuloma, Giant Cell / Q000000981:diagnostic imaging; D050276:Hand Bones / Q000000981:diagnostic imaging*; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging*; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging; D050279:Metacarpal Bones / Q000000981:diagnostic imaging; D008875:Middle Aged; D010002:Osteitis Fibrosa Cystica / Q000000981:diagnostic imaging; D010024:Osteoporosis / Q000000981:diagnostic imaging; D010281:Parathyroid Hormone / Q000032:analysis; D011862:Radiography, Panoramic / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000378:metabolism; D014652:Vascular Diseases / Q000000981:diagnostic imaging
chemical_list: D010281:Parathyroid Hormone