A Study of the Possibility of Predicting Osteoporosis Using Periapical Radiographs
The aims of this study were to evaluate whether change in trabecular pattern in periapical radiographs can be used to predict osteoporosis and to assess the accuracy of the prediction. Mandibular premolar periapical radiographs of 39 post-menopausal women who had at least two premolar teeth in the same quadrant were made using the paralleling technique and processed in an automatic processor. These women also had bone mineral density (BMD) measured by DEXA at 3 locations. Two reference films, one for a normal group (BMD not less than -1SD) and the other for an osteopenia/osteoporosis group, were selected. These periapical radiographs were presented to five observers to identify whether the trabecular pattern represented the normal or osteopenia/osteoporosis group. Observers examined the radiographs three times at intervals of one to two weeks. Sensitivity, specificity, positive predictive value and negative predictive value were calculated. Receiver Operating Characteristic (ROC) curves were also plotted and Az was calculated. Intra-observer and inter-observer agreement were evaluated using CohenÃs kappa index. Intra-observer agreement ranged from moderate to substantial. Interobserver agreement also varied from fair to substantial. Overall mean sensitivity, specificity, positive predictive value and negative predictive value were 50.7%, 74.3%, 73.8% and 51.2%, respectively. The average area under the ROC curve was 0.64. The results of this study suggest that a dense trabecular pattern in the mandibular premolar region in post-menopausal women could be a sign of not having osteopenia/ osteoporosis. This study shows that it is possible to use periapical radiographs in helping to identify women with low risk of osteopenia/ osteoporosis.
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