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Detection of post-menopausal women with low bone mineral density and elevated biochemical markers of bone turnover by panoramic radiographs

¹Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, Japan; ²Department of Oral and Maxillofacial Radiology, Division of Medical Intelligence and Informatics, Graduate School of Biomedical Sciences, Hiroshima University, Japan; ³Department of Obstetrics and Gynecology, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Japan; ⁴Department of Orthodontics, School of Dentistry, University of Washington, Seattle, USA

*Correspondence to: Akira Taguchi, Department of Oral and Maxillofacial Radiology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan; E-mail: akiro{at}hiroshima-u.ac.jp

Received 23 October 2007; revised 14 December 2007; accepted 26 December 2007

Objectives: The detection of an eroded mandibular cortex on panoramic radiographs and questionnaire-based screening tools show similar diagnostic efficacies for identifying osteoporosis in post-menopausal women. We evaluated whether both tools also have similar diagnostic performances in identifying women with osteoporosis and elevated biochemical markers of bone turnover who have a high risk of fracture.

Methods: Urinary N-telopeptide cross-links of type I collagen (NTx) (corrected for creatinine) and serum levels of total non-bone-specific alkaline phosphatase (ALP) were measured in 99 post-menopausal women aged 44–70 years (mean±standard deviation (SD), 54.6±5.2 years) who underwent bone mineral density (BMD) assessment and panoramic radiography. BMD was measured at the lumbar spine and femoral neck using dual energy X-ray absorptiometry. The Female Osteoporosis Self-assessment Tool for Asia (FOSTA), which is based on age and weight, was used as the questionnaire-based screening tool. Osteoporosis was defined as a BMD T-score of –2.5 or less at either the lumbar spine or the femoral neck.

Results: Urinary NTx and serum ALP were significantly associated with cortical erosion, but not with the FOSTA. The areas under the receiver operating characteristics (ROC) curve for identifying participants with osteoporosis were 0.784 for FOSTA and 0.827 for the detection of cortical erosion, and for identifying participants with osteoporosis and elevated urinary NTx they were 0.700 for FOSTA and 0.807 for the detection of cortical erosion.

Conclusions: Our results suggest that panoramic radiography is superior to questionnaire-based screening for identifying women who are at high risk of fracture.

Keywords: osteoporosis; menopause; radiographs; bone turnover