Prediction of low bone mass using a combinational approach of cortical and trabecular bone measures from dental panoramic radiographs

Abstract

The aim of this study is to extract cortical and trabecular features of the mandible and to develop a novel combinational model of mandibular cortical thickness, trabecular bone area and age in order to predict low bone mineral density or osteoporosis from a dental panoramic radiograph. The study involved 64 south Indian women (age = 52.5 ± 12.7 years) categorised into two groups (normal and low bone mineral density) based on total femur bone mineral density. The dental panoramic radiographs were obtained by a digital scanner, and measurement of total bone mineral density at the right femur was performed by a dual-energy X-ray absorptiometry scanner. The mandibular cortical thickness and panoramic mandibular index were measured bilaterally, and the mean values were considered. The region of interest of 128 × 128 pixels around the mental foramen region was manually cropped and subjected to pre-processing, normalisation and average threshold-based segmentation to determine trabecular bone area. Multiple linear regression analyses of cortical and trabecular measures along with age were performed to develop a combinational model to classify subjects as normal and low bone mineral density. The proposed approach demonstrated strong correlation (r = 0.76; p < 0.01) against the total bone mineral density and resulted in accuracy, sensitivity and positive predictive values of 0.84, 0.92 and 0.85, respectively; the receiver operating characteristic outcomes disclosed that the area under the curve was 0.89.Our results suggest that the proposed combinational model could be useful to diagnose subjects with low bone mineral density.

Dental imaging of trabecular bone structure for systemic disorder screening: A systematic review

“…Groups of participants diagnosed with osteoporosis were compared against patients considered as having normal BMD in 10 studies (Chai, Chau, Chung, & Chow, ; Kathirvelu & Anburajan, ; Khojastehpour, Mogharrabi, Dabbaghmanesh, & Nasrabadi, ; Lee & White, ; Mostafa, Arnout, & Fotouh, ; Oliveira et al, ; Roberts, Graham, & Devlin, ; Sindeaux et al, ; Tosoni, Lurie, Cowan, & Burleson, ; Yamashita‐Mikami et al, ). Radiographic modalities such as conventional film and digital panoramic, intraoral film radiographs, CT, and micro‐CT scans were explored and compared to the BMD score.…”

“…For panoramic radiographs, Oliveira et al () found strong positive rank coefficient ( r ) correlation ( r = 0.90) between fractal dimension analysis of the mandibular body and osteoporosis in postmenopausal women ( p < 0.05). Kathirvelu and Anburajan () showed 84% inter‐reliability between radiologists while measuring radiographs. They segmented the average values of pixels as a threshold.…”

“…Regarding osteoporosis studies ( n = 10), seven of them found evidence that alveolar cancellous bone and its trabecular bone alter its pattern when a systemic disorder is present (Chai et al, ; Kathirvelu & Anburajan, ; Khojastehpour et al, ; Lee & White, ; Oliveira et al, ; Roberts et al, ; Tosoni et al, ). Three studies demonstrated that isolated fractal dimension or pixel intensity analysis from the trabecular bone was not able to distinguish between diseased and health control groups (Mostafa et al, ; Sindeaux et al, ; Yamashita‐Mikama et al, ).…”

“…In general, retrospective and prospective studies that investigated the trabecular bone pattern via dental radiographs found positive correlation with the reference standard for a variety of systemic diseases. Although there were differences in study design, these studies found a common ground in concluding that the trabecular bone density appears to be a useful screening index for systemic disorders, which alter bone density (Chai et al, ; Kathirvelu & Anburajan, ; Khojastehpour et al, ; Lee & White, ; Nemtoi et al, ; Oliveira et al, ; Roberts et al, ; Tosoni et al, ; Yamashita‐Mikami et al, ).…”

“…These radiographs modalities are commonly and annually obtained on dental follow‐ups; therefore, a more accessible screening opportunity (Lee & White, ; Padbury et al, ). The current systematic review demonstrated that the complex trabecular microarchitecture of the mandible could be affected by systemic diseases, which alter bone structure and turnover (Chai et al, ; Kathirvelu & Anburajan, ; Khojastehpour et al, ; Lee & White, ; Nemtoi et al, ). Previous in vitro research supports combination of trabecular bone analysis and its geometry for prediction of the bone mechanical competency as accurately as DXA in osteoporotic patients (Pulkkinen et al, ).…”