Diagnosis of osteoporosis using cortex mandibular indices based on cortex thickness and morphology in comparison with visual assessment of the cortex

Introduction: Osteoporosis is a common condition causing significant morbidity and mortality. There is some evidence of a correlation between bone mineral density of the mandible and that of the lumbar spine and hip. The ability to accurately detect osteoporosis based on routine dental imaging would allow early diagnosis. The aim of this study was to compare the diagnostic accuracy for low bone mineral density using mandibular radio morphometric indices versus simple visual inspection of the mandibular cortex. Materials and Methods: Four independent investigators evaluated radio morphometric indices (mental index, antigonial index and morphology of the cortex) as well as assigning a rating of thin or normal cortex based on their initial impression on the panoramic radiographs of 49 post menopausal women with decreased bone mineral density and 42 unaffected controls. The sensitivity, specificity and positive predictive value for each index was evaluated. Results: The mental and antegonial index had better sensitivity than specificity and positive predictive value. However the opposite was true for the morphology index and simple visual inspection of cortical thickness. External agreement was moderate to perfect (0.41 -0.93) for cortex morphology, and moderate to substantial (0.49-0.76) for simple visual inspection of cortical thickness but excellent for mandibular and antegonial index ( 0.8). Conclusion: We found that the mandibular cortical thickness is affected in postmenopausal women with low bone mineral density when compared to controls. Furthermore radio morphometric indices and morphology are more accurate in the diagnosis of osteoporosis than simple visual assessment of cortical thickness.