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Overview
According to new research from the University of Manchester, image analysis software is under development for measuring mandibular cortical width in digitized panoramic radiographs as a potential screening test for osteoporosis. The study received online coverage from WebMD  and other news agencies. This research points toward greater future integration of oral health in the patient’s overall medical care. However, the technology still has some way to go. As the researchers acknowledge in the study, there is diagnostic potential for panoramic radiographs in the early detection of osteoporosis, but the technologies are still under investigation to determine the precise threshold for minimizing false positives.
Osteoporosis is a systemic skeletal disorder characterized by low bone mass and fragility, especially for postmenopausal women. Although the condition affects women primarily, it also occurs in men and is commonly associated with a decrease in bone mineral density. The condition has several modifiable risk factors, including smoking, inadequate dietary calcium and estrogen deficiency. Previous research has also reported an association between osteoporosis and tooth loss, along with alveolar bone loss. Based on current estimates, over 10 million Americans over the age of 50 have osteoporosis, and nearly 34 million individuals are at risk.1
The new study, published in the online edition of the journal Bone 2, was performed as part of a three-year evaluation called the OSTEODENT project, which recruited 652 women aged 45 to 70 from four European centers, based in Greece, Belgium, Sweden and England. The research team developed analytical software, based on active shape modeling, to measure the width of the mandibular cortex on digitized panoramic radiographs. The researchers looked specifically at mandibular cortical width because of its reported correlation with bone mineral density at the hip, lumbar spine and forearm, three common areas of osteoporotic bone fracture.
Results from the computerized evaluation of panoramic radiographs were compared to a standard method of diagnosing osteoporosis: dual energy X-ray absorptiometry (DXA) of the hip, spine or femoral neck. With DXA scans, 140 women were identified as having osteoporosis at one of the three measurement sites. By comparison, the software evaluation of panoramic radiographs identified over half of the 140 women whose osteoporotic status was confirmed with DXA scans. The research team claimed that, with further refinement, more at-risk individuals could be identified using their software-based screening test for skeletal osteoporosis.
Because the diagnostic accuracy of cortical width measurements is less than perfect, the dental panoramic radiograph would not be taken for osteoporosis screening per se, but could be evaluated for osteoporosis if the radiographs were exposed for dental purposes. The researchers also caution that radiographic measurements cannot be used as the sole basis for referral, and that the patient's medical history must be evaluated before undertaking further referral or investigation.
As technology develops, dentists may become ideally situated to observe and monitor bone loss in their patients, regardless of age or gender, which may be a sign of bone loss in other parts of the body. Dentists are encouraged to refer patients suspected of being at risk for osteoporosis—based on medical history, including risk factors, and results of clinical and
X-ray examination—to their primary-care physician for a complete health assessment.
Footnotes
1 U.S. Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General, 2004. Available at: “http://www.surgeongeneral.gov/ library/bonehealth/content.html “. Accessed January 10, 2006 .
2 Devlin H, Allen PD, Graham J, Jacobs R, Karayianni K, Lindh C, van der Stelt PF, Harrison E, Adams JE, Pavitt S, Horner K. Automated osteoporosis risk assessment by dentists: as new pathway to diagnosis. Bone 2006 Dec 21; [Epub ahead of print].
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A-Z Topics: Radiography/X-Rays
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Science in the News is a service by the American Dental Association (ADA) to present current information about science topics in the news. The ADA is a professional association of dentists committed to the public's oral health, ethics, science and professional advancement; leading a unified profession through initiatives in advocacy, education, research and the development of standards. As a science-based organization, the ADA's evaluation of the scientific evidence may change as more information becomes available. Your thoughts would be greatly appreciated.
Page Posted January 2007
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