CC BY-NC-ND 4.0 · Ann Natl Acad Med Sci 2021; 57(02): 100-107
DOI: 10.1055/s-0041-1724462
Original Article

Diagnostic Validity of Orthopantomogram Compared to Dual Energy X-ray Absorptiometry Scan in Detecting Osteoporosis

D. Prasanna Kumar
1   Department of Oral Medicine and Radiology, Adhiparasakthi Dental College and Hospital, Melmaruvathur, Tamil Nadu, India
S. Jayachandran
2   Department of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital, Chennai, India
N. Thilagavathy
1   Department of Oral Medicine and Radiology, Adhiparasakthi Dental College and Hospital, Melmaruvathur, Tamil Nadu, India
› Author Affiliations


Introduction Osteoporosis is one of the most common and rampant metabolic bone disorders among the geriatric, particularly affecting postmenopausal women. Even though resorption tends to occur more rapidly in bones with a higher proportion of trabecular bone (e.g., vertebrae, pelvis, calcaneus), bones with significant cortical bone content also do undergo resorption, for example, mandible. The dental manifestations that may indicate low-bone density include loose teeth, receding gums, and ill-fitting or loose dentures.

Objective To validate the efficacy of orthopantomograms (OPGs) in recognizing bone mineral density (BMD) changes of the mandible using mandibular cortical index (MCI) and substantiate the same with dual energy X-ray absorptiometry (DEXA) scan on femoral neck and spine.

Materials and Methods This cross-sectional study comprised 60 geriatric patients of both genders. All the patients were subjected to panoramic radiographs wherever clinically indicated. The visual analysis was done based on the radiographic appearance of the mandibular cortical border and results were compared with DEXA scan reports, followed by an analysis of three grades of MCI and BMD statistically.

Results In our study, out of 40 patients in C2 and C3 subgroups, 67% and 20% were normal, respectively. The incidence of osteopenia was 33% in the C2 group and 70% in the C3 group, whereas Osteoporosis was present only among 10% of the population in the C3 group. The difference between the groups are statistically significant (p = 0.01). These findings imply that a progressive link exists between BMD and deteriorating cortical morphology.

Conclusion The purpose of this study is that dentists will be able to refer patients to physicians of suspected low BMD, based on incidental findings on panoramic radiographs for further examination. There is a statistically significant correlation present between DEXA and MCI, so the latter can also be used for screening BMD changes.

Publication History

Article published online:
13 April 2021

© 2021. National Academy of Medical Sciences (India). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Sabzwari S, Azhar G. Ageing in Pakistan—A new challenge. Ageing Int 2010; 36 (04) 423-427
  • 2 Horner K, Devlin H. The relationships between two indices of mandibular bone quality and bone mineral density measured by dual energy X-ray absorptiometry. Dentomaxillofac Radiol 1998; 27 (01) 17-21
  • 3 Lundström A, Jendle J, Stenström B, Toss G, Ravald N. Periodontal conditions in 70-year-old women with osteoporosis. Swed Dent J 2001; 25 (03) 89-96
  • 4 Delmas PD, Marin F, Marcus R, Misurski DA, Mitlak BH. Beyond hip: importance of other nonspinal fractures. Am J Med 2007; 120 (05) 381-387
  • 5 Khosla S, Amin S, Orwoll E. Osteoporosis in men. Endocr Rev 2008; 29 (04) 441-464
  • 6 Richards JB, Kavvoura FK, Rivadeneira F. et al. Genetic Factors for Osteoporosis Consortium. Collaborative meta-analysis: associations of 150 candidate genes with osteoporosis and osteoporotic fracture. Ann Intern Med 2009; 151 (08) 528-537
  • 7 Center JR, Bliuc D, Nguyen TV, Eisman JA. Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 2007; 297 (04) 387-394
  • 8 Raisz LG. Pathogenesis of osteoporosis: concepts, conflicts, and prospects. J Clin Invest 2005; 115 (12) 3318-3325
  • 9 Varthakavi PK, Joshi AS, Bhagwat NM, Chadha MD. Osteoporosis treatment in India: Call for action. Indian J Endocrinol Metab 2014; 18 (04) 441-442
  • 10 van den Bergh B, Karagozoglu KH, Heymans MW, Forouzanfar T. Aetiology and incidence of maxillofacial trauma in Amsterdam: a retrospective analysis of 579 patients. J Craniomaxillofac Surg 2012; 40 (06) e165-e169
  • 11 Kumar P, Singh SV, Aggarwal H, Alvi HA. Call for detection of osteoporosis in India-can a dentist help?. Indian J Endocrinol Metab 2014; 18 (06) 871
  • 12 Andre F, Paulo T, Claudia M, Nilse S. Correlation between seven panoramic radiomorphometric indices and bone mineral density in postmenopausal women. Oral Surg Oral Pathol Oral Radiol Oral Endodont 2010; 109 (03) 449-456
  • 13 Ishii K, Taguchi A, Nakamoto T. et al. Diagnostic efficacy of alveolar bone loss of the mandible for identifying postmenopausal women with femoral osteoporosis. Dentomaxillofac Radiol 2007; 36 (01) 28-33
  • 14 Amorim MA, Takayama L, Jorgetti V, Pereira RM. Comparative study of axial and femoral bone mineral density and parameters of mandibular bone quality in patients receiving dental implants. Osteoporos Int 2007; 18 (05) 703-709
  • 15 Devlin H, Allen P, Graham J. et al. The role of the dental surgeon in detecting osteoporosis: the OSTEODENT study. Br Dent J 2008; 204 (10) E16-E16
  • 16 Taguchi A. Triage screening for osteoporosis in dental clinics using panoramic radiographs. Oral Dis 2010; 16 (04) 316-327
  • 17 Bhatnagar S, Krishnamurthy V, Pagare SS. Diagnostic efficacy of panoramic radiography in detection of osteoporosis in post-menopausal women with low bone mineral density. J Clin Imaging Sci 2013; 3: 23
  • 18 Marandi S, Bagherpour A, Imanimoghaddam M, Hatef M, Haghighi A. Panoramic-based mandibular indices and bone mineral density of femoral neck and lumbar vertebrae in women. J Dent (Tehran) 2010; 7 (02) 98-106
  • 19 Nagler RM, Hershkovich O. Relationships between age, drugs, oral sensorial complaints and salivary profile. Arch Oral Biol 2005; 50 (01) 7-16
  • 20 Balcikonyte E, Balciuniene I, Alekna V. Panoramic radiographs in assessment of the bone mineral density. Stomatologija 2004; 6: 17-19
  • 21 Mundy GR. Osteoporosis: pathophysiology and non-pharmacological management. Best Pract Res Clin Rheumatol 2001; 15 (05) 727-745
  • 22 Watanabe PC, Oliveira TM, Monteiro SA. et al. Morphodigital study of the mandibular trabecular bone in panoramic radiographs. Int J Morphol 2007; 25: 875-880
  • 23 Kanis JA, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A. Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone 2000; 27 (05) 585-590
  • 24 Mahl CRW, Licks R, Fontanella VRC. Comparison of morphometric indices obtained from dental panoramic radiography for identifying individuals with osteoporosis/osteopenia. Radiol Bras 2008; 41: 183-187
  • 25 Gaur B, Chaudhary A, Wanjari PV, Sunil M, Basavaraj P. Evaluation of panoramic Radiographs as a screening tool of osteoporosis in post menopausal women: a cross sectional study. J Clin Diagn Res 2013; 7 (09) 2051-2055
  • 26 Sutthiprapaporn P, Taguchi A, Nakamoto T. et al. Diagnostic performance of general dental practitioners after lecture in identifying post-menopausal women with low bone mineral density by panoramic radiographs. Dentomaxillofac Radiol 2006; 35 (04) 249-252
  • 27 Drozdzowska B, Pluskiewicz W. Longitudinal changes in mandibular bone mineral density compared with hip bone mineral density and quantitative ultrasound at calcaneus and hand phalanges. Br J Radiol 2002; 75 (897) 743-747
  • 28 Taguchi A, Ohtsuka M, Nakamoto T. et al. Identification of post-menopausal women at risk of osteoporosis by trained general dental practitioners using panoramic radiographs. Dentomaxillofac Radiol 2007; 36 (03) 149-154
  • 29 Kumar P, Singh SV, Aggarwal H, Alvi HA. Call for detection of osteoporosis in India-can a dentist help?. Indian J Endocrinol Metab 2014; 18 (06) 871
  • 30 Jowitt N, MacFarlane T, Devlin H, Klemetti E, Horner K. The reproducibility of the mandibular cortical index. Dentomaxillofac Radiol 1999; 28 (03) 141-144
  • 31 Taguchi A, Tanimoto K, Suei Y. The estimation of the radiomorphometric indices of the mandible using panoramic radiography. Dent Radiol 1993; 33: 309-316
  • 32 Halling A, Persson GR, Berglund J, Johansson O, Renvert S. Comparison between the Klemetti index and heel DXA BMD measurements in the diagnosis of reduced skeletal bone mineral density in the elderly. Osteoporos Int 2005; 16 (08) 999-1003
  • 33 Taguchi A, Tsuda M, Ohtsuka M. et al. Use of dental panoramic radiographs in identifying younger postmenopausal women with osteoporosis. Osteoporos Int 2006; 17 (03) 387-394