title: Severe secondary hyperparathyroidism and panoramic radiography parameters.
abstract: OBJECTIVE
  Renal osteodystrophy (RO) are skeletal abnormalities seen in patients with secondary hyperparathyroidism (SHPT). This study aims to evaluate the effects of RO using panoramic radiography parameters. Furthermore, the correlation between these parameters and parathyroid hormone (PTH) levels was tested.
  
  
  METHODS
  Qualitative (mandibular cortical index/trabecular bone pattern) and quantitative parameters (mental index/calcification and resorption foci) were applied from panoramic radiographs of chronic kidney disease (CKD) patients and controls. Frequency distribution and descriptive analysis were used to compare the results of both groups. Spearman's correlation coefficient evaluated the correlation between serum PTH levels of CKD patients and the radiographic parameters. Intra- and interobserver agreement was tested using the intraclass correlation coefficient and kappa index.
  
  
  RESULTS
  Intra- and interobserver agreement was respectively excellent (0.81-1.00) and good (0.61-0.80). Qualitative parameters demonstrate significant difference compared with the control group. Mean mental index was lower in patients with CKD (3.17 ± 1.35 mm), but the difference was not significant. Calcification/resorption foci (3.63 ± 2.07) of CKD patients were significantly more present than in the control group (p = 0.0001). PTH levels were correlated with mental index, mandibular cortical index and trabecular bone pattern (respectively, 0.0034, 0.0315, and 0.0370).
  
  
  CONCLUSIONS
  RO presented a number of characteristic bone metabolic effects in the jaws that could be observed on panoramic radiographs. Radiographs of CKD patients demonstrate significantly more calcification and resorption.
  
  
  CONCLUSIONS
  The mental index, mandibular cortical index, and trabecular bone pattern are good parameters for evaluating the effects of RO on severe secondary hyperparathyroidism.
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
authors.initials: JC
authors.lastname: de Melo 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: D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000150:complications* / Q000473:pathology; D015588:Observer Variation; D010281:Parathyroid Hormone / Q000097:blood; D011862:Radiography, Panoramic
chemical_list: D010281:Parathyroid Hormone