Dental x-rays could be first step in osteoporosis screening

Panoramic dental x-rays can be used to help identify postmenopausal women with low skeletal bone mineral density (BMD), meaning that screening for spinal osteoporosis could begin in the dentist’s office a new study shows.

The study included 316 postmenopausal women who had no symptoms of osteoporosis. The women were divided into two groups: 159 had no history of hysterectomy, oophorectomy or estrogen use, the remaining 157 had one or more of these histories. All had panoramic dental x-rays, and the cortical shape and width of the jaw were estimated on the x-rays. “Women with eroded cortical shape need to be referred for further BMD testing,” said Akira Taguchi, DDS, PhD, department of oral and maxillofacial radiology at Hiroshima University Hospital in Japan.

Currently, questionnaires are widely used as the first step in determining which women need to have further BMD testing. This study found that dental x-rays were just as sensitive as questionnaires in identifying those women. Dental x-rays, looking at cortical shape, were 87% sensitive in identifying women with spinal osteoporosis in the group with no history of hysterectomy, oophorectomy or estrogen use and 80% sensitive for the other group. The questionnaire was found to have an 87% sensitivity rate for the women with no history and 72% for those with the history of hysterectomy, oophorectomy or estrogen use, Dr. Taguchi said.

Dr. Taguchi noted that dental x-rays are not as specific as questionnaires, meaning that dental x-rays indicate disease when there isn’t any and can indicate there isn’t any disease and there is. However, since dental x-rays are already being done (about 15 million a year in the U.S.) they can be reviewed just as a first step in determining which women need additional testing, he said.

“The response rate for questionnaires may be relatively low if postmenopausal women have little information or no interest regarding osteoporosis,” Dr. Taguchi said. On the other hand, “because dental panoramic x-rays are taken for the diagnosis of conditions affecting the teeth and jaws in clinical practice worldwide, the dentist could also look at the mandibular cortical shape and width and refer the appropriate women for further BMD testing,” he said.