The measurement of mandibular cortical bone height in osteoporotic vs. non‐osteoporotic postmenopausal women

Abstract

The asymptomatic progression of osteoporosis, in conjunction with the possibility of catastrophic disability, makes this disorder a major public health priority. Various body sites, including the mandible, have shown susceptibility to decreasing bone density. In 1986, Benson et al. proposed a radiomorphometric technique called the Panoramic Mandibular Index (PMI) as an inexpensive noninvasive dental technique for osteoporosis screening, although no osteoporotic subjects were included in their study. The purpose of our study was to determine whether osteoporotic postmenopausal women would show a decrease in mandibular cortical bone height, as measured by the PMI index, when compared with nonosteoporotic postmenopausal women. Seventy-two Caucasian females (33 cases/39 controls), aged 54-71 years old, were selected through records and screening via a dual-energy x-ray absorptiometry scan (LUNAR-DEXA). ANOVA analysis indicated no differences in the mean PMI between case and control groups (0.37 +/- 0.15 and 0.38 +/- 0.13, respectively; p = 0.69). Other techniques, such as computer digitized radiography should be explored to test the validity of the PMI.

Osteoporosis and oral bone loss.

“…120 The authors suggested that the muscles of mastication may influence BMDs in regions of muscular insertion. 120 For the 355 women of this study group, panoramic radiographs were also obtained, and significant associations were found between ridge-height measurements derived from these radiographs and femoral and vertebral BMDs (as determined by DEXA and mandibular cortical and trabecular BMDs (as determined by QCT); however, when sensitivity (the ability to detect the presence of osteoporosis) was balanced with specificity (the ability to detect the absence of osteoporosis), the measures had little better than chance performance,' 21 · 122 similar to the findings of another group who used one of these measures (the ratio of the thickness of the inferior mandibular cortex divided by the distance from the border to the mental foramen and were unable to distinguish between normal and osteoporotic women (as determined by DEXA), 123 but in contrast to the findings of another group who, with a similar ratio, determined that ridge-height ratios 124 · 125 were significantly higher in edentulous men («=16) than in women (« = 28), that the ratios were significantly related to age and to osteoporosis severity (as determined from lateral and frontal spine radiographs), and that there were nearly significant relationships between the ratio and parathyroid hormone levels and calcitonin levels. 126 Several years later, another group of investigators used this ridge-height ratio 124 · 125 and were able to distinguish between women with and without thoracic fractures.…”

The relationship between panoramic radiomorphometric indices and the femoral bone mineral density of edentulous patients

“…Watson et al [28] found no differences in the mean PMI between normal and osteoporotic women aged 54-71 years (0.38 and 0.37, respectively). In addition, Drozdzowska et al [3] studied 30 healthy, postmenopausal edentulous women divided into normal, osteopenic, and osteoporotic groups and found no significant difference in the mean PMI (0.34, 0.43, and 0.37, respectively).…”

Panoramic radiographs for identifying individuals with undetected osteoporosis

“…This index can overcome some of the shortcomings of GI and AI measurements. Benson et al have already defined new radiomorphometric index, the panoramic mandibular index (PMI), calculated as the cortical width below the mental foramen (the MCW) divided by the distance between the mental foramen and inferior border of the mandible [39]; however, measurement error due to both the MCW and distance between the mental foramen and inferior border of the mandible is likely to markedly influence the results [40][41][42][43][44][45]. In addition, the recognition of accurate position of the mental foramen may differ amongst different examiners.…”