Comparison between the Klemetti index and heel DXA BMD measurements in the diagnosis of reduced skeletal bone mineral density in the elderly

Abstract

Osteopenia/osteoporosis affect many elderly people and might not be detected until symptoms of fractures occur. Early detection of osteopenia/osteoporosis is important and would allow preventive measures and treatment. Access to screening for osteopenia/osteoporosis is often limited, whereas panoramic radiography is commonly used in dentistry. The aim of this study was to determine the validity of the Klemetti index (KI), measured on panoramic radiographs, in the diagnosis of osteopenia/osteoporosis as defined by a bone mineral density (BMD) measurement below -1.5 standard deviations (SDs) of a community based sample. In total, 211 consecutive participants (102 men and 109 women) 60-96 years in the SNAC-Blekinge study (Swedish National Study on Ageing and Care) underwent bone densitometry [by dual-energy X-ray absorptiometry (DXA)] of both heels. A panoramic radiograph was taken of each participant, and mandibular cortex on a panoramic radiograph was classified as '0' or normal (even and sharp endosteal margin), '1', moderately eroded (evidence of lacunar resorption or endosteal cortical residues), or '2', severely eroded (unequivocal porosity). From logistic regression, the odds ratio of having a BMD measurement below -1.5 SD was 8.04 (95% CI 2.39 to 27.12, P<0.001) in the 'osteopenic' (KI category 2), compared with the 'normal' group (KI categories 0 and 1). Receiver operating characteristic (ROC) curve analysis was used to measure the validity of the KI indicating osteopenia (KI category 2) in predicting reduced BMD. This point provided a sensitivity of 50% and a specificity of 89%. Positive and negative predictive values were 21% and 97%, respectively. There were 87% correctly classified subjects. The area under the ROC curve was 0.64. The present study demonstrated that a negative finding (KI category <2) is highly predictive of the absence of osteopenia/osteoporosis as defined by the DXA measurements.

Decrease in Mandibular Cortical in Patients With Type 1 Diabetes Mellitus Combined with Poor Glycemic Control

“…Studies have shown that MCI can be used as an indicator of low mandibular BMD, fracture risk and bone remodeling (2,13,16). Researches with different populations assessed their diagnostic capability in relation to DEXA values as reference in the diagnosis of osteoporosis, obtaining satisfactory sensitivity and specificity degrees (17,18). Thus, although based on visual qualitative analysis, the MCI can be used to identify mandibular cortical alterations.…”

Influence of Dental Status, Age and Gender on the Cortical Width of the Lower Border of the Mandible and Mandibular Cortical Index

“…Neki autori (11,12) smatraju da vrijednosti MCI-a omogućuju prepoznavanje razlike između žene s osteoporozom i bez te bolesti. MCI se temelji na Klemettijevoj klasifikaciji promjena u donjem korteksu mandibule izmjerenih na ortopantomografskoj slici (13).…”

“…Some authors (11,12) consider that MCI enables to distinguish between normal and osteoporotic women. The MCI is based on Klemetti's classification of changes in inferior cortex of the mandible which can be observed on panoramic x-ray images.…”

Radiografia panorâmica: instrumento auxiliar no diagnóstico da osteoporose

“…Do mesmo modo, as densidades minerais ósseas apresentaram maiores valores em pacientes classificadas como C1. Pacientes classificadas como C1 eram predominantemente normais ou osteopê-nicas, enquanto as pacientes C3 eram osteopênicas ou possuíam diagnóstico densitométrico de osteoporose (50)(51)(52)(53) . A espessura da cortical mandibular abaixo do forame mentual também apresenta correlação com a densidade mineral óssea da coluna lombar e do fêmur proximal (15,47,54) .…”

“…Em estudo com 211 pacientes, Halling et al (50) demonstraram correlação entre o índice mandibular cortical e a densidade mineral óssea do calcâneo. Os pacientes com erosão acentuada na cortical possuíam densidade mineral óssea de calcâneo significativamente menor do que o grupo sem erosão ou com erosão moderada.…”