Trabecular pattern in the mandible as an indicator of osteoporosis in post menopausal women - A radiological study

Objectives: To detect the changes in the trabecular pattern of the mandible in the post menopausal women using direct digital radiography (DDR) system & their correlation with the bone mineral density (BMD) measured at the femoral neck. The study also explored the possibility of using trabecular pattern on the mandibular intraoral periapical direct digital radiograph as a diagnostic tool to identify individuals at risk of osteoporosis. Study design: 40 healthy dentate post menopausal women, between the age group of 40-60 years were included. The detailed case history was recorded followed by oral examination. Intraoral digital radiograph of the mandibular premolar region was done. BMD evaluation was done at the hip region using Dual energy X-ray absorptiometry(DXA). The digital radiographs were evaluated by three observers and classified into sparse, heterogenous & dense trabecular patterns. The intra and inter observer variation was evaluated. The fractal dimension (D-value) was analysed in the region of interest (ROI) selected between the premolars using ImageJ software. Results: Statistical suggestive significance was observed when age was correlated with the T-score. The D-value obtained in our study showed statistical significance when correlated with both the T-score and the assessed trabecular patterns. Conclusion: The fractal box analysis of the intraoral DDR can act as an identification tool in the diagnosis of the patients with the risk of osteoporosis. Thereby oral diagnosticians are in a pivotal position to screen for osteoporosis and identify patients at the risk of osteoporosis.