Imaging Sci Dent.  2016 Sep;46(3):185-202. 10.5624/isd.2016.46.3.185.

IDIOS: An innovative index for evaluating dental imaging-based osteoporosis screening indices

• Barngkgei
• Halboub E
• Almashraqi AA
• Khattab R
• Al Haffar

• KMID: 2408251
• DOI: http://doi.org/10.5624/isd.2016.46.3.185

Abstract

PURPOSE
The goal of this study was to develop a new index as an objective reference for evaluating current and newly developed indices used for osteoporosis screening based on dental images. Its name; IDIOS, stands for Index of Dental-imaging Indices of Osteoporosis Screening.
MATERIALS AND METHODS
A comprehensive PubMed search was conducted to retrieve studies on dental imaging-based indices for osteoporosis screening. The results of the eligible studies, along with other relevant criteria, were used to develop IDIOS, which has scores ranging from 0 (0%) to 15 (100%). The indices presented in the studies we included were then evaluated using IDIOS.
RESULTS
The 104 studies that were included utilized 24, 4, and 9 indices derived from panoramic, periapical, and computed tomographic/cone-beam computed tomographic techniques, respectively. The IDIOS scores for these indices ranged from 0 (0%) to 11.75 (78.32%).
CONCLUSION
IDIOS is a valuable reference index that facilitates the evaluation of other dental imaging-based osteoporosis screening indices. Furthermore, IDIOS can be utilized to evaluate the accuracy of newly developed indices.

Keyword

Radiography, Dental; Diagnosis; Absorptiometry, Photon; Osteoporosis

MeSH Terms

Absorptiometry, Photon
Diagnosis
Mass Screening*
Osteoporosis*
Radiography, Dental

Reference

1. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy, March 7-29, 2000: highlights of the conference. South Med J. 2001; 94:569–573.

2. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994; 843:1–129.

3. Guglielmi G. Preface. Imaging of osteoporosis. Radiol Clin North Am. 2010; 48:xv.

4. United Nations Scientific Committee on the Effects of Atomic Radiation. Hereditary effects of radiation: UNSCEAR Report to the general assembly with scientific annex. New York: United Nations;2001.

5. Mozzo P, Procacci C, Tacconi A, Martini PT, Andreis IA. A new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. Eur Radiol. 1998; 8:1558–1564.

6. Karayianni K, Horner K, Mitsea A, Berkas L, Mastoris M, Jacobs R, et al. Accuracy in osteoporosis diagnosis of a combination of mandibular cortical width measurement on dental panoramic radiographs and a clinical risk index (OSIRIS): the OSTEODENT project. Bone. 2007; 40:223–229.

7. Passos JS, Gomes Filho IS, Sarmento VA, Sampaio DS, Gonçalves FP, Coelho JM, et al. Women with low bone mineral density and dental panoramic radiography. Menopause. 2012; 19:704–709.

8. Damilakis J, Vlasiadis K. Have panoramic indices the power to identify women with low BMD at the axial skeleton? Phys Med. 2011; 27:39–43.

9. Božič M, Ihan Hren N. A novel method of dental panoramic tomogram analysis: a perspective tool for a screening test for osteoporosis. J Craniomaxillofac Surg. 2013; 41:808–815.

10. Bozic M, Ihan Hren N. Osteoporosis and mandibles. Dentomaxillofac Radiol. 2006; 35:178–184.

11. Dutra V, Devlin H, Susin C, Yang J, Horner K, Fernandes AR. Mandibular morphological changes in low bone mass edentulous females: evaluation of panoramic radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102:663–668.

12. Devlin H, Horner K. Mandibular radiomorphometric indices in the diagnosis of reduced skeletal bone mineral density. Osteoporos Int. 2002; 13:373–378.

13. White SC, Atchison KA, Gornbein JA, Nattiv A, Paganini-Hill A, Service SK, et al. Change in mandibular trabecular pattern and hip fracture rate in elderly women. Dentomaxillofac Radiol. 2005; 34:168–174.

14. Mohajery M, Brooks SL. Oral radiographs in the detection of early signs of osteoporosis. Oral Surg Oral Med Oral Pathol. 1992; 73:112–117.

15. Kribbs PJ, Chesnut CH 3rd, Ott SM, Kilcoyne RF. Relationships between mandibular and skeletal bone in an osteoporotic population. J Prosthet Dent. 1989; 62:703–707.

16. Lurie A, Tosoni GM, Tsimikas J, Walker F Jr. Recursive hierarchic segmentation analysis of bone mineral density changes on digital panoramic images. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 113:549–558.e1.

17. Rehman DE, Qureshi S, Abdul Haq A. Early detection of osteoporosis from incisure depth of human mandible in an orthopantomogram. J Pak Med Assoc. 2014; 64:766–769.

18. Horner K, Devlin H, Alsop CW, Hodgkinson IM, Adams JE. Mandibular bone mineral density as a predictor of skeletal osteoporosis. Br J Radiol. 1996; 69:1019–1025.

19. Drozdzowska B, Pluskiewicz W, Tarnawska B. Panoramic-based mandibular indices in relation to mandibular bone mineral density and skeletal status assessed by dual energy X-ray absorptiometry and quantitative ultrasound. Dentomaxillofac Radiol. 2002; 31:361–367.

20. Hirai T, Ishijima T, Hashikawa Y, Yajima T. Osteoporosis and reduction of residual ridge in edentulous patients. J Prosthet Dent. 1993; 69:49–56.

21. Cakur B, Dagistan S, Harorli A, Ezmeci EB. The mandibular angle in osteoporotic men. Med Oral Patol Oral Cir Bucal. 2011; 16:e181–e184.

22. Klemetti E, Kolmakov S, Kröger H. Pantomography in assessment of the osteoporosis risk group. Scand J Dent Res. 1994; 102:68–72.

23. Taguchi A, Suei Y, Ohtsuka M, Otani K, Tanimoto K, Hollender LG. Relationship between bone mineral density and tooth loss in elderly Japanese women. Dentomaxillofac Radiol. 1999; 28:219–223.

24. Valerio CS, Trindade AM, Mazzieiro ET, Amaral TP, Manzi FR. Use of digital panoramic radiography as an auxiliary means of low bone mineral density detection in post-menopausal women. Dentomaxillofac Radiol. 2013; 42:20120059.

25. Lee BD, White SC. Age and trabecular features of alveolar bone associated with osteoporosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 100:92–98.

26. Law AN, Bollen AM, Chen SK. Detecting osteoporosis using dental radiographs: a comparison of four methods. J Am Dent Assoc. 1996; 127:1734–1742.

27. Leite AF, Figueiredo PT, Guia CM, Melo NS, de Paula AP. Correlations between seven panoramic radiomorphometric indices and bone mineral density in postmenopausal women. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109:449–456.

28. Watanabe PC, Dias FC, Issa JP, Monteiro SA, de Paula FJ, Tiossi R. Elongated styloid process and atheroma in panoramic radiography and its relationship with systemic osteoporosis and osteopenia. Osteoporos Int. 2010; 21:831–836.

29. Kathirvelu D, Anburajan M. Prediction of low bone mass using a combinational approach of cortical and trabecular bone measures from dental panoramic radiographs. Proc Inst Mech Eng H. 2014; 228:890–898.

30. 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. 2006; 17:1494–1500.

31. Lindh C, Petersson A, Rohlin M. Assessment of the trabecular pattern before endosseous implant treatment: diagnostic outcome of periapical radiography in the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996; 82:335–343.

32. Jonasson G, Bankvall G, Kiliaridis S. Estimation of skeletal bone mineral density by means of the trabecular pattern of the alveolar bone, its interdental thickness, and the bone mass of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 92:346–352.

33. Hassani-Nejad A, Ahlqwist M, Hakeberg M, Jonasson G. Mandibular trabecular bone as fracture indicator in 80-yearold men and women. Eur J Oral Sci. 2013; 121:525–531.

34. Koh KJ, Kim KA. Utility of the computed tomography indices on cone beam computed tomography images in the diagnosis of osteoporosis in women. Imaging Sci Dent. 2011; 41:101–106.

35. Barngkgei I, Al Haffar I, Khattab R. Osteoporosis prediction from the mandible using cone-beam computed tomography. Imaging Sci Dent. 2014; 44:263–271.

36. Klemetti E, Vainio P, Lassila V, Alhava E. Trabecular bone mineral density of mandible and alveolar height in postmenopausal women. Scand J Dent Res. 1993; 101:166–170.

37. Springe B, Slaidina A, Soboleva U, Lejnieks A. Bone mineral density and mandibular residual ridge resorption. Int J Prosthodont. 2014; 27:270–276.

38. Naitoh M, Kurosu Y, Inagaki K, Katsumata A, Noguchi T, Ariji E. Assessment of mandibular buccal and lingual cortical bones in postmenopausal women. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 104:545–550.

39. Office of the Surgeon General. Bone health and osteoporosis: a report of the surgeon general. Rockville: Office of the Surgeon General;2004.

40. Taguchi A. Triage screening for osteoporosis in dental clinics using panoramic radiographs. Oral Dis. 2010; 16:316–327.

41. Bras J, van Ooij CP, Abraham-Inpijn L, Kusen GJ, Wilmink JM. Radiographic interpretation of the mandibular angular cortex: a diagnostic tool in metabolic bone loss. Part I. Normal state. Oral Surg Oral Med Oral Pathol. 1982; 541–545.

42. Devlin H, Allen PD, Graham J, Jacobs R, Karayianni K, Lindh C, et al. Automated osteoporosis risk assessment by dentists: a new pathway to diagnosis. Bone. 2007; 40:835–842.

43. Roberts M, Yuan J, Graham J, Jacobs R, Devlin H. Changes in mandibular cortical width measurements with age in men and women. Osteoporos Int. 2011; 22:1915–1925.

44. Nakamoto T, Taguchi A, Ohtsuka M, Suei Y, Fujita M, Tsuda M, et al. A computer-aided diagnosis system to screen for osteoporosis using dental panoramic radiographs. Dentomaxillofac Radiol. 2008; 37:274–281.

45. Kavitha MS, Samopa F, Asano A, Taguchi A, Sanada M. Computer-aided measurement of mandibular cortical width on dental panoramic radiographs for identifying osteoporosis. J Investig Clin Dent. 2012; 3:36–44.

46. White SC, Rudolph DJ. Alterations of the trabecular pattern of the jaws in patients with osteoporosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 88:628–635.

47. Licks R, Licks V, Ourique F, Radke Bittencourt H, Fontanella V. Development of a prediction tool for low bone mass based on clinical data and periapical radiography. Dentomaxillofac Radiol. 2010; 39:224–230.

48. White SC, Taguchi A, Kao D, Wu S, Service SK, Yoon D, et al. Clinical and panoramic predictors of femur bone mineral density. Osteoporos Int. 2005; 16:339–346.

49. Bodade PR, Mody RN. Panoramic radiography for screening postmenopausal osteoporosis in India: a pilot study. Oral Health Dent Manag. 2013; 12:65–72.

50. Miliuniene E, Alekna V, Peciuliene V, Tamulaitiene M, Maneliene R. Relationship between mandibular cortical bone height and bone mineral density of lumbar spine. Stomatologija. 2008; 10:72–75.

51. Dutra V, Susin C, da Costa NP, Veeck EB, Bahlis A, Fernandes Ada R. Measuring cortical thickness on panoramic radiographs: a validation study of the Mental Index. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 104:686–691.

52. Alkurt MT, Peker I, Sanal O. Assessment of repeatability and reproducibility of mental and panoramic mandibular indices on digital panoramic images. Int Dent J. 2007; 57:433–438.

53. Hedström L, Baigi A, Bergh H. The relation between bone mineral density in the heel and pixel intensity in the mandibular jaw bone among elderly women. Dentomaxillofac Radiol. 2010; 39:409–413.

54. Nackaerts O, Jacobs R, Devlin H, Pavitt S, Bleyen E, Yan B, et al. Osteoporosis detection using intraoral densitometry. Dentomaxillofac Radiol. 2008; 37:282–287.

55. Singh M, Nagrath AR, Maini PS. Changes in trabecular pattern of the upper end of the femur as an index of osteoporosis. J Bone Joint Surg Am. 1970; 52:457–467.

56. Roberts MG, Graham J, Devlin H. Image texture in dental panoramic radiographs as a potential biomarker of osteoporosis. IEEE Trans Biomed Eng. 2013; 60:2384–2392.

57. Klemetti E, Kolmakov S, Heiskanen P, Vainio P, Lassila V. Panoramic mandibular index and bone mineral densities in postmenopausal women. Oral Surg Oral Med Oral Pathol. 1993; 75:774–779.

58. Klemetti E, Vainio P, Lassila V, Alhava E. Cortical bone mineral density in the mandible and osteoporosis status in postmenopausal women. Scand J Dent Res. 1993; 101:219–223.

59. Bodic F, Amouriq Y, Gayet-Delacroix M, Maugars Y, Hamel L, Basle MF, et al. Relationships between bone mass and micro-architecture at the mandible and iliac bone in edentulous subjects: a dual X-ray absorptiometry, computerised tomography and microcomputed tomography study. Gerodontology. 2012; 29:e585–e594.

60. Jonasson G, Sundh V, Hakeberg M, Hassani-Nejad A, Lissner L, Ahlqwist M. Mandibular bone changes in 24 years and skeletal fracture prediction. Clin Oral Investig. 2013; 17:565–572.

61. Kim OS, Shin MH, Song IH, Lim IG, Yoon SJ, Kim OJ, et al. Digital panoramic radiographs are useful for diagnosis of osteoporosis in Korean postmenopausal women. Gerodontology. 2016; 33:185–192.

62. Devlin H, Karayianni K, Mitsea A, Jacobs R, Lindh C, van der Stelt P, et al. Diagnosing osteoporosis by using dental panoramic radiographs: the OSTEODENT project. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 104:821–828.

63. Nakamoto T, Taguchi A, Ohtsuka M, Suei Y, Fujita M, Tanimoto K, et al. Dental panoramic radiograph as a tool to detect postmenopausal women with low bone mineral density: untrained general dental practitioners' diagnostic performance. Osteoporos Int. 2003; 14:659–664.

64. Taguchi A, Ohtsuka M, Nakamoto T, Naito K, Tsuda M, Kudo Y, et al. Identification of post-menopausal women at risk of osteoporosis by trained general dental practitioners using panoramic radiographs. Dentomaxillofac Radiol. 2007; 36:149–154.

65. Taguchi A, Asano A, Ohtsuka M, Nakamoto T, Suei Y, Tsuda M, et al. Observer performance in diagnosing osteoporosis by dental panoramic radiographs: results from the osteoporosis screening project in dentistry (OSPD). Bone. 2008; 43:209–213.

66. Jowitt N, MacFarlane T, Devlin H, Klemetti E, Horner K. The reproducibility of the mandibular cortical index. Dentomaxillofac Radiol. 1999; 28:141–144.

67. Govindraju P, Chandra P. Radiomorphometric indices of the mandible - an indicator of osteoporosis. J Clin Diagn Res. 2014; 8:195–198.

68. Dagistan S, Bilge OM. Comparison of antegonial index, mental index, panoramic mandibular index and mandibular cortical index values in the panoramic radiographs of normal males and male patients with osteoporosis. Dentomaxillofac Radiol. 2010; 39:290–294.

69. 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; 7:2051–2055.

70. Cakur B, Dagistan S, Sumbullu MA. No correlation between mandibular and non-mandibular measurements in osteoporotic men. Acta Radiol. 2010; 51:789–792.

71. Savic Pavicin I, Dumancic J, Jukic T, Badel T, Badanjak A. Digital orthopantomograms in osteoporosis detection: mandibular density and mandibular radiographic indices as skeletal BMD predictors. Dentomaxillofac Radiol. 2014; 43:20130366.

72. Sindeaux R, Figueiredo PT, de Melo NS, Guimaraes AT, Lazarte L, Pereira FB, et al. Fractal dimension and mandibular cortical width in normal and osteoporotic men and women. Maturitas. 2014; 77:142–148.

73. Alman AC, Johnson LR, Calverley DC, Grunwald GK, Lezotte DC, Hokanson JE. Diagnostic capabilities of fractal dimension and mandibular cortical width to identify men and women with decreased bone mineral density. Osteoporos Int. 2012; 23:1631–1636.

74. Tosoni GM, Lurie AG, Cowan AE, Burleson JA. Pixel intensity and fractal analyses: detecting osteoporosis in perimenopausal and postmenopausal women by using digital panoramic images. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102:235–241.

75. Koh KJ, Park HN, Kim KA. Prediction of age-related osteoporosis using fractal analysis on panoramic radiographs. Imaging Sci Dent. 2012; 42:231–235.

76. Geraets WG, Verheij JG, van der Stelt PF, Horner K, Lindh C, Nicopoulou-Karayianni K, et al. Prediction of bone mineral density with dental radiographs. Bone. 2007; 40:1217–1221.

77. Ezoddini Ardakani F, Owlia MB, Hesami S, Hosseini P. Digital panoramic radiography as a useful tool for detection of bone loss: a comparative study. Acta Med Iran. 2013; 51:94–100.

78. Gulsahi A, Paksoy CS, Ozden S, Kucuk NO, Cebeci AR, Genc Y. Assessment of bone mineral density in the jaws and its relationship to radiomorphometric indices. Dentomaxillofac Radiol. 2010; 39:284–289.

79. Cakur B, Dagistan S, Sahin A, Harorli A, Yilmaz A. Reliability of mandibular cortical index and mandibular bone mineral density in the detection of osteoporotic women. Dentomaxillofac Radiol. 2009; 38:255–261.

80. Vlasiadis KZ, Skouteris CA, Velegrakis GA, Fragouli I, Neratzoulakis JM, Damilakis J, et al. Mandibular radiomorphometric measurements as indicators of possible osteoporosis in postmenopausal women. Maturitas. 2007; 58:226–235.

81. Johari Khatoonabad M, Aghamohammadzade N, Taghilu H, Esmaeili F, Jabbari Khamnei H. Relationship among panoramic radiography findings, biochemical markers of bone turnover and hip BMD in the diagnosis of postmenopausal osteoporosis. Iran J Radiol. 2011; 8:23–28.

82. Yaşar F, Akgünlü F. The differences in panoramic mandibular indices and fractal dimension between patients with and without spinal osteoporosis. Dentomaxillofac Radiol. 2006; 35:1–9.

83. 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.

84. Ishii K, Taguchi A, Nakamoto T, Ohtsuka M, Sutthiprapaporn P, Tsuda M, et al. Diagnostic efficacy of alveolar bone loss of the mandible for identifying postmenopausal women with femoral osteoporosis. Dentomaxillofac Radiol. 2007; 36:28–33.

85. Persson RE, Hollender LG, Powell LV, MacEntee MI, Wyatt CC, Kiyak HA, et al. Assessment of periodontal conditions and systemic disease in older subjects. I. Focus on osteoporosis. J Clin Periodontol. 2002; 29:796–802.

86. Okabe S, Morimoto Y, Ansai T, Yoshioka I, Tanaka T, Taguchi A, et al. Assessment of the relationship between the mandibular cortex on panoramic radiographs and the risk of bone fracture and vascular disease in 80-year-olds. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106:433–442.

87. 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; 16:999–1003.

88. Erdogan O, Incki KK, Benlidayi ME, Seydaoglu G, Kelekci S. Dental and radiographic findings as predictors of osteoporosis in postmenopausal women. Geriatr Gerontol Int. 2009; 9:155–164.

89. Cakur B, Sahin A, Dagistan S, Altun O, Caglayan F, Miloglu O, et al. Dental panoramic radiography in the diagnosis of osteoporosis. J Int Med Res. 2008; 36:792–799.

90. Taguchi A, Ohtsuka M, Nakamoto T, Suei Y, Kudo Y, Tanimoto K, et al. Detection of post-menopausal women with low bone mineral density and elevated biochemical markers of bone turnover by panoramic radiographs. Dentomaxillofac Radiol. 2008; 37:433–437.

91. Khojastehpour L, Afsa M, Dabbaghmanesh MH. Evaluation of correlation between width and morphology of mandibular inferior cortex in digital panoramic radiography and postmenopausal osteoporosis. Iran Red Crescent Med J. 2011; 13:181–186.

92. Hastar E, Yilmaz HH, Orhan H. Evaluation of mental index, mandibular cortical index and panoramic mandibular index on dental panoramic radiographs in the elderly. Eur J Dent. 2011; 5:60–67.

93. Al-Dam A, Blake F, Atac A, Amling M, Blessmann M, Assaf A, et al. Mandibular cortical shape index in non-standardised panoramic radiographs for identifying patients with osteoporosis as defined by the German Osteology Organization. J Craniomaxillofac Surg. 2013; 41:e165–e169.

94. Martinez-Maestre MA, Corcuera Flores JR, Machuca G, Gonzalez-Cejudo C, Torrejon R, Castelo-Branco C. Panoramic radiomorphometry and vertebral fractures in Spanish postmenopausal women. Maturitas. 2013; 76:364–369.

95. 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; 7:98–106.

96. Taguchi A, Sanada M, Krall E, Nakamoto T, Ohtsuka M, Suei Y, et al. Relationship between dental panoramic radiographic findings and biochemical markers of bone turnover. J Bone Miner Res. 2003; 18:1689–1694.

97. Kiswanjaya B, Yoshihara A, Deguchi T, Hanada N, Miyazaki H. Relationship between the mandibular inferior cortex and bone stiffness in elderly Japanese people. Osteoporos Int. 2010; 21:433–438.

98. Ferreira Leite A, de Souza Figueiredo PT, Ramos Barra F, Santos de Melo N, de Paula AP. Relationships between mandibular cortical indexes, bone mineral density, and osteoporotic fractures in Brazilian men over 60 years old. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 112:648–656.

99. Taguchi A, Ohtsuka M, Tsuda M, Nakamoto T, Kodama I, Inagaki K, et al. Risk of vertebral osteoporosis in post-menopausal women with alterations of the mandible. Dentomaxillofac Radiol. 2007; 36:143–148.

100. Horner K, Karayianni K, Mitsea A, Berkas L, Mastoris M, Jacobs R, et al. The mandibular cortex on radiographs as a tool for osteoporosis risk assessment: the OSTEODENT Project. J Clin Densitom. 2007; 10:138–146.

101. Taguchi A, Tsuda M, Ohtsuka M, Kodama I, Sanada M, Nakamoto T, et al. Use of dental panoramic radiographs in identifying younger postmenopausal women with osteoporosis. Osteoporos Int. 2006; 17:387–394.

102. Taguchi A, Suei Y, Sanada M, Ohtsuka M, Nakamoto T, Sumida H, et al. Validation of dental panoramic radiography measures for identifying postmenopausal women with spinal osteoporosis. AJR Am J Roentgenol. 2004; 183:1755–1760.

103. Yamada S, Uchida K, Iwamoto Y, Sugino N, Yoshinari N, Kagami H, et al. Panoramic radiography measurements, osteoporosis diagnoses and fractures in Japanese men and women. Oral Dis. 2015; 21:335–341.

104. Taguchi A, Suei Y, Ohtsuka M, Otani K, Tanimoto K, Ohtaki M. Usefulness of panoramic radiography in the diagnosis of postmenopausal osteoporosis in women. Width and morphology of inferior cortex of the mandible. Dentomaxillofac Radiol. 1996; 25:263–267.

105. Arifin AZ, Asano A, Taguchi A, Nakamoto T, Ohtsuka M, Tsuda M, et al. Computer-aided system for measuring the mandibular cortical width on dental panoramic radiographs in identifying postmenopausal women with low bone mineral density. Osteoporos Int. 2006; 17:753–759.

106. Allen PD, Graham J, Farnell DJ, Harrison EJ, Jacobs R, Nicopolou-Karayianni K, et al. Detecting reduced bone mineral density from dental radiographs using statistical shape models. IEEE Trans Inf Technol Biomed. 2007; 11:601–610.

107. Taguchi A, Sugino N, Miki M, Kozai Y, Mochizuki N, Osanai H, et al. Detecting young Japanese adults with undetected low skeletal bone density using panoramic radiographs. Dentomaxillofac Radiol. 2011; 40:154–159.

108. Kavitha MS, Asano A, Taguchi A, Kurita T, Sanada M. Diagnosis of osteoporosis from dental panoramic radiographs using the support vector machine method in a computer-aided system. BMC Med Imaging. 2012; 12:1.

109. Hekmatin E, Ahmadi SS, Ataiekhorasgani M, Feizianfard M, Jafaripozve S, Jafaripozve N. Prediction of lumbar spine bone mineral density from the mandibular cortical width in postmenopausal women. J Res Med Sci. 2013; 18:951–955.

110. Vlasiadis KZ, Damilakis J, Velegrakis GA, Skouteris CA, Fragouli I, Goumenou A, et al. Relationship between BMD, dental panoramic radiographic findings and biochemical markers of bone turnover in diagnosis of osteoporosis. Maturitas. 2008; 59:226–233.

111. Kavitha MS, Asano A, Taguchi A, Heo MS. The combination of a histogram-based clustering algorithm and support vector machine for the diagnosis of osteoporosis. Imaging Sci Dent. 2013; 43:153–161.

112. Devlin H, Allen P, Graham J, Jacobs R, Nicopoulou-Karayianni K, Lindh C, et al. The role of the dental surgeon in detecting osteoporosis: the OSTEODENT study. Br Dent J. 2008; 204:E16. discussion 560-1.

113. Lee K, Taguchi A, Ishii K, Suei Y, Fujita M, Nakamoto T, et al. Visual assessment of the mandibular cortex on panoramic radiographs to identify postmenopausal women with low bone mineral densities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 100:226–231.

114. Papamanthos M, Varitimidis S, Dailiana Z, Kogia E, Malizos K. Computer-assisted evaluation of Mandibular Cortical Width (MCW) index as an indicator of osteoporosis. Hippokratia. 2014; 18:251–257.

115. Nagi R, Devi BKY, Rakesh N, Reddy SS, Santana N, Shetty N. Relationship between femur bone mineral density, body mass index and dental panoramic mandibular cortical width in diagnosis of elderly postmenopausal women with osteoporosis. J Clin Diagn Res. 2014; 8:ZC36–ZC40.

116. Horner K, Devlin H, Harvey L. Detecting patients with low skeletal bone mass. J Dent. 2002; 30:171–175.

117. Jagelaviciene E, Kubilius R, Krasauskiene A. The relationship between panoramic radiomorphometric indices of the mandible and calcaneus bone mineral density. Medicina (Kaunas). 2010; 46:95–103.

118. Jagelaviciene E, Krasauskiene A, Zalinkevicius R, Kubilius R, Vaitkeviciene I. The relationship between the calcaneal bone mineral density and the mental index in post-menopausal females. Dentomaxillofac Radiol. 2013; 42:20120050.

119. Watson EL, Katz RV, Adelezzi R, Gift HC, Dunn SM. The measurement of mandibular cortical bone height in osteoporotic vs. non-osteoporotic postmenopausal women. Spec Care Dentist. 1995; 15:124–128.

120. Mohammad AR, Alder M, McNally MA. A pilot study of panoramic film density at selected sites in the mandible to predict osteoporosis. Int J Prosthodont. 1996; 9:290–294.

121. Faber TD, Yoon DC, Service SK, White SC. Fourier and wavelet analyses of dental radiographs detect trabecular changes in osteoporosis. Bone. 2004; 35:403–411.

122. Lindh C, Horner K, Jonasson G, Olsson P, Rohlin M, Jacobs R, et al. The use of visual assessment of dental radiographs for identifying women at risk of having osteoporosis: the OSTEODENT project. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106:285–293.

123. Chai J, Chau AC, Chu FC, Chow TW. Diagnostic performance of mandibular bone density measurements in assessing osteoporotic status. Int J Oral Maxillofac Implants. 2014; 29:667–674.