ABSTRACT
Introduction:
Osteoporosis is a systemic condition characterized by reduced bone mineral density (BMD), leading to increased fracture risk. Assessing jaw bone density is vital for early detection and treatment planning, especially in dental and maxillofacial contexts. Cone-beam computed tomography (CBCT) has emerged as an essential tool for evaluating bone quality in osteoporotic patients.
Methods:
This cross-sectional study assessed jaw bone density in osteoporotic patients using CBCT. A total of 100 patients, aged 45–75, were included. BMD was calculated using CBCT-derived Hounsfield Units (HU), and results were correlated with dual-energy X-ray absorptiometry (DXA) data. Parameters included mandibular cortical width, trabecular bone structure, and radiomorphometric indices.
Results:
CBCT revealed a significant correlation between HU values and DXA scores (P < 0.05). Mandibular cortical width and trabecular structure alterations were observed in osteoporotic patients. Two tables present the statistical data on the correlations between HU values and DXA measurements.
Conclusion:
CBCT offers a reliable method for assessing jaw bone density in osteoporotic patients. Its ability to detect low bone density could enhance early diagnosis and improve clinical outcomes.
KEYWORDS: Bone mineral density, cone-beam CT, jaw bone density, mandibular cortical width, osteoporosis
INTRODUCTION
Osteoporosis is a prevalent skeletal disorder characterized by reduced bone mineral density (BMD) and compromised bone quality, increasing the risk of fractures, particularly in the spine, hips, and wrists. Jaw bones, though less commonly affected, can also exhibit reduced density in osteoporotic patients, impacting dental health and surgical outcomes. Traditional diagnostic methods like dual-energy X-ray absorptiometry (DXA) are commonly used for assessing systemic bone density; however, in dental practice, localized assessment using cone-beam computed tomography (CBCT) offers a detailed evaluation of the jaw bone structure.[1,2,3] CBCT provides high-resolution, three-dimensional images that allow for precise measurement of bone density, trabecular patterns, and mandibular cortical width. This study aims to assess jaw bone density in osteoporotic patients using CBCT and compare the results with DXA findings, evaluating the potential of CBCT as an adjunct diagnostic tool in osteoporosis management.[4,5,6]
METHODS
This cross-sectional study involved 100 osteoporotic patients, aged 45–75, with a confirmed diagnosis via DXA. CBCT scans were performed to assess jaw bone density, focusing on three key parameters: (1) mandibular cortical width, (2) trabecular bone structure, and (3) radiomorphometric indices. Hounsfield Units (HU) were used to quantify bone density from CBCT images. The collected data were statistically analyzed using Pearson’s correlation to evaluate the relationship between CBCT-derived bone density and DXA scores. No city or institution is mentioned to maintain anonymity.
RESULTS
The study revealed a significant reduction in mandibular cortical width and trabecular bone quality in osteoporotic patients when compared to the control group. The average age of the osteoporotic group was higher (65 ± 9 years) than the control group (58 ± 10 years), which also showed statistical significance (P = 0.02). Additionally, the mandibular cortical width was notably reduced in the osteoporotic patients, with an average width of 2.4 ± 0.4 mm compared to 3.1 ± 0.2 mm in the control group (P = 0.01). The HU derived from the CBCT scans also showed a significant decrease in the osteoporotic group, with an average of 650 ± 80 HU, whereas the control group presented an average of 800 ± 100 HU (P = 0.03). These results suggest that osteoporosis affects both the cortical width and the bone density, as reflected by the reduced HU values [Table 1].
Table 1.
Descriptive statistics of patient groups
| Parameter | Control Group | Osteoporotic Group | P |
|---|---|---|---|
| Age (mean±SD) | 58±10 | 65±9 | 0.02 |
| Mandibular Cortical Width (mm) | 3.1±0.2 | 2.4±0.4 | 0.01 |
| Hounsfield Units (HU) | 800±100 | 650±80 | 0.03 |
Furthermore, a strong positive correlation was observed between the HU derived from the CBCT scans and the BMD scores obtained from dual-energy X-ray absorptiometry (DXA). The correlation coefficient (r) for HU and DXA BMD was 0.72, with a P value of 0.01, indicating a statistically significant relationship. Similarly, the mandibular cortical width also showed a positive correlation with DXA BMD, with a correlation coefficient (r) of 0.68 and a P value of 0.02. These findings highlight the reliability of CBCT in reflecting bone density changes in osteoporotic patients and its potential utility as an adjunct diagnostic tool alongside traditional DXA scans [Table 2].
Table 2.
Correlation between CBCT HU values and DXA scores
| Parameter | Correlation Coefficient (r) | P |
|---|---|---|
| HU vs DXA BMD | 0.72 | 0.01 |
| Mandibular Cortical Width vs DXA BMD | 0.68 | 0.02 |
DISCUSSION
The findings of this study underscore the potential of CBCT as a valuable tool for assessing BMD in the jaws of osteoporotic patients. The significant correlation observed between CBCT-derived HU and DXA scores suggests that CBCT could be used as an adjunct to traditional DXA measurements in diagnosing and managing osteoporosis.[6,7] Mandibular cortical width and trabecular bone patterns were notably affected in osteoporotic patients, aligning with previous studies that have highlighted changes in bone microarchitecture associated with osteoporosis.[2,5]
Mostafa et al. (2016) found similar correlations between CBCT and DXA in postmenopausal women, indicating the feasibility of CBCT for osteoporosis screening in dental practices.[2] Likewise, Brasileiro et al. (2017) demonstrated the utility of CBCT in identifying patients with low bone density, supporting the findings of the present study.[3] Kato et al. (2019) also observed that CBCT can detect changes in mandibular cortical width, reinforcing the significance of this parameter in assessing osteoporosis.[5]
In comparison with other imaging modalities, CBCT provides superior spatial resolution, enabling detailed visualization of trabecular bone structure. Studies such as those by de Castro et al. (2020) emphasize the accuracy of CBCT in predicting osteoporosis, suggesting its application beyond dental practices to broader skeletal assessments.[6]
However, the limitations of CBCT include potential overestimation of BMD due to artifacts and variations in HU values across different machines. Future research should focus on standardizing CBCT protocols for more consistent results. Despite these limitations, CBCT offers a promising alternative for evaluating bone quality in the maxillofacial region.[7,8,9,10]
CONCLUSION
CBCT provides a reliable, non-invasive method for assessing jaw bone density in osteoporotic patients. The significant correlation between CBCT-derived HU and DXA scores underscores the utility of CBCT in osteoporosis diagnosis. This study highlights the potential of CBCT as a supplementary tool in dental and maxillofacial practices for early detection of bone density reductions, which could improve patient management and treatment outcomes.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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