Osteoporotic alterations in a group of different ethnicity Brazilian postmenopausal women: An observational study

Radiomorphometric indices of the mandible as indicators of decreased bone mineral density and osteoporosis - meta-analysis and systematic review

This review aims to evaluate the accuracy of various mandibular radiomorphometric indices in comparison with DEXA BMD measurements in the diagnosis of osteopenia and osteoporosis based on a meta-analysis of the sensitivity and specificity of the indices. PRISMA statement was followed. The materials for analysis were collected in August 2023 by searching three databases: PubMed Central, Web of Science, and Scopus. The selection of studies consisted of three selection stages, and 64 articles were finally obtained. Quality assessment was performed with the QUADAS-2 tool, and the general methodological quality of retrieved studies was low. Statistical analysis was performed based on 2 × 2 tables and estimated sensitivity and specificity were obtained using SROC curves. The most used indices were MCI, MCW and PMI. The best results in detecting reduced BMD obtained for MCW ≤ 3 mm, estimated sensitivity and specificity were 0.712 (95% CI, 0.477-0.870) and 0.804 (95% CI, 0.589-0.921), respectively. The most prone to the risk of bias is the MCI due to the examiner's subjectivism. Radiomorphometric indices of the mandible can be useful as a screening tool to identify patients with low BMD, but should not be used as a diagnostic method. Further research needs to focus on analysing the ability of the indices to detect osteoporosis and also in combination the indices with clinical parameters.

Assessment of mandibular cortical index in patients with hepatic cirrhosis: A case-control study

AIMS

To assess the presence of alterations suggestive of reduced bone mineral density (BMD) by using mandibular cortical index (MCI) in panoramic radiographs of cirrhotic individuals and to evaluate their relationship with other characteristics of hepatic cirrhosis (HC).

METHODS AND RESULTS

This is an observational case-control study assessing the medical records of 165 cirrhotic patients matched by sex and age with healthy individuals. MELD (model of end stage liver disease) score, etiology, complications, comorbidities, and serum levels of vitamin D were collected. MCI was used to obtain BMD. Binary logistic regression was used to test associations and the risk estimates were expressed in odds ratio. Most of the sample consisted of men (73.93%) with median age of 56 years old. In the study group, the mean value of MELD was 16.5 and hepatitis C was the main etiology of HC (33.9%). Cirrhotic individuals are 3.99 times more likely to present alterations suggestive of reduced BMD (p < .01). There was no statistical significance in the association of MCI with levels of vitamin D, comorbidities, etiology or cirrhosis complications.

CONCLUSIONS

MCI suggestive of reduced BMD is more likely to be identified in panoramic radiographs of cirrhotic individuals than of healthy ones.

Characteristics of healthy German children and adolescents across tertiles of calcaneal stiffness index

Aim

Identifying risk factors for low bone stiffness index (SI) might be one crucial strategy for osteoporosis prevention. Purpose was to characterize healthy schoolchildren across tertiles of SI.

Subject and methods

In 248 girls (13.4 ± 1.9 years, BMI: 20.2 ± 4.8 kg/m2) and 231 boys (13.6 ± 1.7 years, BMI: 19.3 ± 3.3 kg/m2), the following parameters were assessed: calcaneal SI (quantitative ultrasound), body composition (bioelectrical impedance analysis), Bone Healthy Eating Index (BoneHEI; food frequency questionnaire), and physical activity level (PAL; activity questionnaire). Participants were classified according to age- and sex-specific SI tertiles (low, medium, and high). Between-group comparisons were achieved by Kruskal–Wallis-H-tests (α = 0.05).

Results

Girls with low SI had significantly lower body mass (49.2 ± 16.7 vs 54.8 ± 12.2 kg; p < 0.01), BMI (19.6 ± 5.4 vs 21.3 ± 3.9 kg/m2; p < 0.0001), fat-free mass (36.3 ± 8.3 vs 39.5 ± 6.0 kg; p < 0.01), and fat mass (23.7 ± 9.1 vs 26.8 ± 7.2%; p < 0.05) compared to those with high SI. In boys, significant differences between low and high SI were obtained for PAL (1.49 ± 0.12 vs 1.56 ± 0.14; p < 0.01). BoneHEI was not significantly different between tertiles in both sexes.

Conclusion

Girls with low body mass and boys with low PAL have a higher risk for low SI. Schoolchildren should strive for normal body mass and perform regular physical activity.

Head and neck radiotherapy-induced changes in dentomaxillofacial structures detected on panoramic radiographs: A systematic review

Purpose

This study aimed to summarize the impact of neck and head radiation treatment on maxillofacial structures detected on panoramic radiographs.

Materials and Methods

In this systematic review, the authors searched PubMed Central, Embase, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar for original research studies up to February 2020 that included the following Medical Subject Headings keywords: words related to “radiotherapy” and synonyms combined with keywords related to “panoramic radiography” and “oral diagnosis” and synonyms. Only original studies in English that investigated the maxillofacial effects of radiotherapy via panoramic radiographs were included. The quality of the selected manuscripts was evaluated by assessing the risk of bias using Cochrane's ROBINS-I tool for non-randomized studies.

Results

Thirty-three studies were eligible and included in this review. The main objectives pertained to the assessment of the effects of radiation on maxillofacial structures, including bone architecture alterations, periodontal space widening, teeth development abnormalities, osteoradionecrosis, and implant bone loss. The number of participants evaluated ranged from 8 to 176.

Conclusion

The interaction between ionizing radiation and maxillofacial structures results in hazard to the tissues involved, particularly the bone tissue, periosteum, connective tissue of the mucosa, and endothelium. Hard tissue changes due to radiation therapy can be detected on panoramic radiographs.

Assessment of bone metabolism biomarkers in serum and saliva of cirrhotic patients

OBJECTIVE

To assess the serum and salivary levels of biomarkers related to bone metabolism in cirrhotic patients as well as the evidence of osteoporotic changes on panoramic radiographs.

MATERIALS AND METHODS

Thirty-eight cirrhotic patients underwent anamnesis and physical examination. Specimens of blood and saliva were collected for evaluation by using Luminex™ xMAP technology to quantify RANKL, OPG, IL-1β, IL-6 and TNF-α. Panoramic radiographs were evaluated based on the mandibular cortical index (MCI) and the resulting data were compared to the expression of biomarkers in serum and saliva. Descriptive data analysis was performed and the Mann-Whitney's test and Spearman's correlation were used.

RESULTS

Most of the sample consisted of males (68.4%) who had cirrhosis mostly resulting from alcoholism (28.9%). Median concentration values of RANKL (74.44 pg/mL), IL-1 β (45.91 pg/mL), IL-6 (67.69 pg/mL) and TNF-α (5.97 pg/mL) in saliva were higher than those observed in serum. In 72.7% of the panoramic radiographs, MCI was found to be suggestive of osteoporotic changes. No statistically significant correlation was observed between salivary and serum expressions of biomarkers or between biomarkers and MCI.

CONCLUSION

RANKL, OPG, IL-1β, IL-6 and TNF-α are expressed differently in serum and saliva and the concentration of these biomarkers is not related to MCI.

CLINICAL RELEVANCE

This study contributes to the study of the mechanisms of osteoporosis in cirrhotic individuals.

Mandibular cortical index in the screening of postmenopausal at low mineral density risk: a systematic review

OBJECTIVES

This systematic literature review addressed the use of mandibular cortical index (MCI), assessed by panoramic radiography, for the identification of postmenopausal women at risk of osteoporosis.

METHODS

Databases were searched for original research studies published from September 2010 to September 2020 using the following keywords: "postmenopausal osteoporosis" and synonyms combined with "panoramic radiography" and synonyms. Only English language manuscripts and studies pertaining to the MCI were selected.

RESULTS

A total of 24 studies were included. The publications were highly heterogeneous in terms of the subject of interest, i.e. the MCI, with some studies comparing the usefulness of the MCI using panoramic radiography and using cone beam computed tomography, and others comparing different radiomorphometric indexes developed for panoramic radiography.

CONCLUSIONS

Based on the literature included in this systematic review, we conclude that the MCI is useful as an auxiliary tool for identifying postmenopausal females at risk of low bone mineral density (BMD), as it correlates with skeletal BMD measured by dual X-ray absorptiometry. Nevertheless, other radiomorphometric indexes obtained from panoramic radiographs, such as panoramic mandibular index, mental index, and mandibular cortical width, are also valuable as auxiliary tools in the identification of postmenopausal females at risk, as they also correlate with BMD. Thus, it is not possible to affirm which index is the most reliable for the identification of postmenopausal females considering the literature screened. PROSPERO registration systematic review CRD42020208152.

Diffusion-weighted magnetic resonance imaging of mandibular bone marrow: do apparent diffusion coefficient values of the cervical vertebrae and mandible correlate with age?

OBJECTIVES

The objective of this investigation was to assess the correlation between the mandible and cervical vertebrae bone marrow apparent diffusion coefficient (ADC), obtained by diffusion-weighted magnetic resonance imaging (DWI), with age; to verify the correlation between ADC values from the mandible and the cervical vertebrae; to describe and assess the differences between ADC values obtained from DWI examinations of distinct mandible areas as well as cervical vertebrae.

METHODS

Thirty imaging examinations with DWI for that included the mandible and C1, C2, C3, and C4 vertebrae in the same examination were included. ADC values were collected from 7 distinct areas in the mandible and the cervical vertebrae. Differences between ADC values and non-parametric correlations were performed.

RESULTS

A total of 270 regions were assessed. No significant difference was found between ADC values of all areas tested. An inverse correlation was found between C2, C3, and C4 vertebrae ADC values and age. The significant correlation of anatomic area ADC values and age were presented as graphics to verify if the linear trend of ADC values and age are in accordance with the literature CONCLUSIONS: The mandible area that most correlates with the cervical vertebrae, using ADC values, is the posterior trabecular area, below the inferior molars. Also, C2, C3, and C4 vertebrae ADC values inversely correlate with age, which demonstrates the bone qualitative changes in bone composition. ADC values may be useful for the qualitative assessment of bone quality to screen patients at osteoporosis risk.

Repercussions of osteoporosis on the maxillofacial complex: a critical overview

INTRODUCTION

We present here a literature review focusing on the repercussions of osteoporosis on the oral and maxillofacial complex. Osteoporosis is a silent metabolic disorder characterized by reduced bone mineral density (BMD), which can lead to bone fractures, particularly affecting elderly women. The prevalence of this disease has increased significantly worldwide, and since it accelerates bone resorption also in the jaw bones, some attention has been paid to possible oral and maxillofacial manifestations.

MATERIALS AND METHODS

The databases PubMed and Google Scholar were searched for reports of oral and maxillofacial changes related to osteoporosis.

RESULTS

Several parameters evaluating bone changes in panoramic radiography have been proposed to estimate osteoporosis-related BMD loss, but they tend to warn about the possibility of osteoporosis, rather than being diagnostic criteria. Meanwhile, it seems that osteoporosis-related BMD loss could delay alveolar bone healing and potentiate bone loss in periodontal disease.

CONCLUSION

Even though orofacial bones are not compromised by osteoporosis as much as the axial/appendicular skeleton, a regular dental follow-up of osteoporotic patients is advised, especially in the case of periodontal disease and maxillofacial surgery. Further controlled longitudinal studies considering the site-specificity of osteogenesis would be helpful regarding this issue.

Clinical guidelines for the application of panoramic radiographs in screening for osteoporosis

Osteoporotic fractures are associated with an increased risk of subsequent fractures, a higher rate of mortality, and incremental medical costs. Incidental findings, which include some measurements related to the mandibular inferior cortex and the alveolar trabecular bone pattern of the mandible determined on panoramic radiographs, are considered to be a useful tool for identifying asymptomatic individuals at risk of having osteoporosis and/or fragility fractures. We undertook a worldwide literature survey and present the following clinical recommendations. Postmenopausal female dental patients with a mandibular inferior cortical width of less than 3 mm on panoramic radiographs may be at risk of having low skeletal bone mineral density (BMD) or osteoporosis, but not fragility fractures. In addition, those with a severely eroded mandibular inferior cortex may have an increased risk of having low skeletal BMD, osteoporosis, and fragility fractures. The alveolar trabecular bone pattern of the mandible might be useful for identifying female dental patients at risk of having fragility fractures, although further investigation is necessary to confirm this possibility. These incidental findings on panoramic radiographs, when used for identifying asymptomatic postmenopausal female patients at risk of having osteoporosis in general dental practice, may be helpful in reducing the incidence of first fractures, with a consequent reduction in the secondary fractures, medical costs, and mortality associated with osteoporotic fragility fractures, without incurring any additional cost.

Association between Body Composition, Physical Activity, Food Intake and Bone Status in German Children and Adolescents

Achieving a high bone mass during childhood and adolescence is important for the prevention of osteoporosis in later life. Herein, the purpose was to assess the relationship of various lifestyle factors and bone outcomes in school children. In 248 girls (13.4 ± 1.9 years, BMI: 20.2 ± 4.8 kg m⁻²) and 231 boys (13.6 ± 1.7 years, BMI: 19.3 ± 3.3 kg m⁻²), bone mass (stiffness index, SI; calcaneal quantitative ultrasonometry), body composition (bioelectrical impedance analysis), food intake (food frequency questionnaire), and physical activity level (PAL; standardized questionnaire) were assessed. The individual food intake of eight food groups was related to the German recommendations (Bone Healthy Eating Index, BoneHEI; 0–100 points). Relationships between SI and lifestyle factors (Spearman´s rank correlation) and the influence of the factors on the variance of SI (multiple linear regression) were tested (α = 0.05). SI correlated with age, BMI, absolute fat-free mass, relative fat mass, PAL, and puberty category score in both girls and boys (r = 0.18–0.56, p < 0.01), but not with BoneHEI (p > 0.05). Age, absolute fat-free mass, sex, and PAL explained 35% of the variance of SI (p < 0.0001): SI = −0.60 + 2.97∙age (years) + 0.65∙fat-free mass (kg) + 6.21∙sex (0 = male, 1 = female) + 17.55∙PAL. Besides age and sex, PAL and fat-free mass are important factors relating to bone health. School children should perform regular physical activity to improve their bone status.

Impact of physical activity, anthropometric, body composition, and dietary factors on bone stiffness in German university students

BACKGROUND

Bone density in the young-adult life is associated with risk for osteoporosis in later life. Next to genetic factors, lifestyle seems to play an important role for bone health. Aim of the study was to clarify the relationship between various lifestyle factors and bone parameters in university students.

METHODS

In 233 women and 52 men (age: 22.7±3.1 vs. 24.0±3.2 years; BMI: 22.2±2.9 vs. 24.2±3.1 kg∙m^-2) the following parameters were assessed: calcaneal Stiffness Index ([SI]; quantitative ultrasound), body composition (bioelectrical impedance analysis), actual and past physical activity level ([PAL]; standardized questionnaire), and food/nutrient intake (3-day dietary record). Sex differences (Mann-Whitney-U-tests), relationships between SI and lifestyle factors (Spearman's rank correlation), and the influence of the factors on the variance of SI (multiple linear regression) were tested (α=0.05).

RESULTS

6.9% of the women and 5.8% of the men were classified as osteopenic (-2.5< T score <-1). Significant correlations between SI and BMI, absolute fat mass and fat-free mass, actual PAL, and physical activity during adolescence were found in women (r=0.18-0.24, all P<0.05), but not in men. Food/nutrient parameters did not significantly correlate with bone outcomes (P>0.05). In multiple regression analysis physical activity during adolescence, actual PAL, and BMI explained 8% of the variance of SI (P<0.0001): SI=32.2+3.5∙physical activity during adolescence [1: very low, 2: low, 3: medium, 4: high, 5: very high] +28.5∙PAL+0.8∙BMI [kg∙m^-2].

CONCLUSIONS

Parameters of physical activity seem to be more important for bone health than nutrition factors. Therefore, high levels of physical activity during childhood, adolescence, and early-adult life are highly recommended to improve bone parameters.

Bone changes in the temporomandibular joints of older adults: A cone-beam computed tomography study

AIMS

To assess the prevalence of degenerative bone changes in the temporomandibular joint (TMJ) of older adults using cone-beam computed tomography (CBCT), and to verify possible associations between these findings and patient health history.

METHODS

CBCT scans comprising both TMJs were acquired for 137 patients aged 65+, regardless of TMD status. Images were assessed by two oral radiologists and evaluated for the presence of flattening, erosion, sclerosis, subchondral cysts, and osteophytes in the TMJ bony components, and self-reported patient systemic health histories were retrieved from records.

RESULTS

There were 59 males, and the mean age was 73.35 ± 6.28. A total of 31.4% had bone changes in both TMJs, and 65.7% had bone changes in at least one side. Bone changes were more prevalent in females, with subchondral cysts (63.3%) and osteophytes (60%) the most common findings. There was a higher prevalence of osteoporosis/osteopenia (38.5%) and connective tissue disorders (39.8%) in patients with TMJ bone changes than in those with normal TMJs.

CONCLUSION

Degenerative bone changes of TMJ were prevalent among older adults, and females were more affected. There was a greater prevalence of osteoporosis/osteopenia and connective tissue disorders in patients with TMJ bone changes than in subjects with normal TMJs.

Ethnic differences in bone mineral density among midlife women in a multi-ethnic Southeast Asian cohort

Chinese Singaporean middle-aged women have significantly lower femoral neck bone mineral density and higher lumbar spine bone mineral density than Malays and Indians, after adjustment for age, body mass index, and height.

PURPOSE

Information regarding mediators of differences in bone mineral density (BMD) among Asian ethnicities are limited. Since the majority of hip fractures are predicted to be from Asia, differences in BMD in Asian ethnicities require further exploration. We compared BMD among the Chinese, Malay, or Indian ethnicities in Singapore, aiming to identify potential mediators for the observed differences.

METHODS

BMD of 1201 women aged 45-69 years was measured by dual-energy X-ray absorptiometry. We examined the associations between ethnicity and BMD at both sites, before and after adjusting for potential mediators measured using standardized questionnaires and validated performance tests.

RESULTS

Chinese women had significantly lower femoral neck BMD than Malay and Indian women. Of the more than 20 variables examined, age, body mass index, and height accounted for almost all the observed ethnic differences in femoral neck BMD between Chinese and Malays. However, Indian women still retained 0.047 g/cm² (95% CI, 0.024, 0.071) higher femoral neck BMD after adjustment, suggesting that additional factors may contribute to the increased BMD in Indians. Although no crude ethnic differences in lumbar spine BMD were observed, adjusted regression model unmasked ethnic differences, wherein Chinese women had 0.061(95% CI, - 0.095, 0.026) and 0.065 (95% CI, - 0.091, 0.038) g/cm² higher lumbar spine BMD compared to Malay and Indian women, respectively.

CONCLUSION

BMD in middle-aged Asian women differ by ethnicity and site. Particular attention should be paid to underweight women of Chinese ethnic origin, who may be at highest risk of osteoporosis at the femoral neck and hence hip fractures.

Disparities in osteoporosis by race/ethnicity, education, work status, immigrant status, and economic status in the United States

AIMS

Osteoporosis is one of the most common bone health diseases affecting older adults in US. Addressing disparities in osteoporosis will help to enhance the quality of bone care in the nation's bone health programs.

MATERIALS & METHODS

We used the data of adult participants of the National Health and Nutrition Examination Survey with reported bone mineral density measured during the periods of 2005-2010 and 2013-2014 to examine disparities in osteoporosis based on race/ethnicity, educational attainment, work status, immigrant status, and economic status in US.

RESULTS

Based on educational attainment, the age- and sex-standardized osteoporosis prevalence (SOP) was highest among those with less than a high school education (HSE) (5.1%, 95% CI (CI): 4.3%-5.9%), whereas it was lowest among those with more than HSE (3.2%, CI: 2.7%-3.6%). Based on work status, SOP was highest among unemployed participants (5.4%, CI: 1.9%-8.9%), whereas it was lowest among working participants (2%, CI: 1.6%-2.4%). Based on immigrant status, SOP was highest among non-citizens (6.4%, CI: 5%-7.8%), whereas it was lowest among those born in US (3.4%, CI: 3.1%-3.7%). Based on economic status, SOP was highest among those with poverty-to-income ratio (PIR) <1 (5.5%, CI: 4.4%-6.5%), whereas it was lowest among those with PIR ≥ 4 (2.4%, CI: 1.9%-2.9%).

CONCLUSIONS

Osteoporosis was more prevalent among US adults who were non-citizens, less educated, unemployed, and had lower income. The observed disparities suggest a need for interventions to promote better quality bone care among the socioeconomically disadvantaged groups.

The relationship between estimated bone strength by finite element analysis at the peripheral skeleton to areal BMD and trabecular bone score at lumbar spine

Bone strength, estimated by finite element (FE) analysis based on high resolution peripheral quantitative computed tomography (HR-pQCT) images is an important contributor to understanding risk of fracture. However, it is a peripheral device and cannot be evaluated in vivo at lumbar spine L1-L4. The aim of this study was to investigate if the axial bone quality can be predicted by strength measurements of peripheral bone. Peripheral bone microarchitecture, areal bone mineral density (aBMD) and trabecular bone score (TBS) were measured in adults individuals (n = 262, 60 years and older; 63% women). Stiffness and failure load were estimated by FE analysis at HR-pQCT images at radius and tibia. Areal BMD and TBS were measured by dual energy X-ray absorptiometry (DXA) at L1-L4. Correlations between peripheral and axial data were estimated for each gender adjusted by age, weight, and height. Areal BMD L1-L4 resulted in weak to moderate significant correlations with stiffness and failure load at radius (women: R² = 0.178, p < 0.05 and R² = 0.187, p < 0.001, respectively; men: R² = 0.454 and R² = 0.451, p < 0.001, respectively) and at tibia (women: R² = 0.211 and R² = 0.216, p < 0.001, respectively; men: R² = 0.488 and R² = 0.502, p < 0.001, respectively). TBS showed a very weak or no correlation with stiffness and failure load at radius (women: R² = 0.148 and R² = 0.150, p < 0.05, respectively; men: R² = 0.108 and R² = 0.106, p < 0.05, respectively) and at tibia (women: R² = 0.146 and R² = 0.150, p < 0.05, respectively; men: R² = 0.072 and R² = 0.078, respectively). These data suggest that aBMD L1-L4 was better explained by peripheral bone strength characteristics than the TBS, mainly in men and tibia is generally the site with a better relationship.