a) BRIEF RESUME OF INTENDED WORK
INTRODUCTION AND NEED FOR THE STUDY
Osteoporosis is defined as ‘a disease characterized by low bone mass and micro-architectural deterioration of bone tissue, leading to enhanced bone fragility and an increase in fracture risks. Osteoporosis in turn is associated with substantial morbidity, increased medical cost & high mortality risk in elderly especially postmenopausal women whose general skeletal bone mass rapidly decreases due to oestrogen deficiency and this process often leads to osteoporosis¹.
Since the disease is preventable diagnostic techniques are of major importance².Bone mass can be measured by several methods including single or dual photon absorptiometry (SPA or DPA), quantitative computed tomography(QCT), single or dual X-ray absorptiometry (SXA or DXA), and quantitative ultrasound(QUS)4
This study highlights the use of the visual assessment of mandibular cortex on panoramic radiograph in postmenopausal women to identify low bone mineral density (osteoporosis).This will be useful as it excludes the need for using costly equipments and is a more economical alternative for initial screening of patients on large scale which is not possible with other above mentioned methods.
REVIEW OF LITERATURE
Various studies have demonstrated that individuals with osteoporosis have altered morphology of the mandible2. A number of mandibular indices based on panoramic radiographs, and image processing and analysis techniques have been developed to allow quantification of mandibular bone mass and trabecular architecture in order to discriminate individuals with osteoporosis from those without osteoporosis3.A case control study in the united states suggested that the mandibular inferior cortex on panoramic radiograph was 0.54mm(12%)thinner in subjects with an osteoporotic fracture compared with controls5.Devlin and Horner reported that a diagnostic threshold for mandibular cortical width of 3mm or less is suggested as the most appropriate threshold for referral for bone densitometry in women. Kaoru & Taguchi did a study on visual assessment of mandibular cortex on panoramic radiograph to identify bone changes in post menopausal women with low bone mineral density and reported its usefulness as an indicator of patients with low BMD1.
OBJECTIVES
To visually assess the mandibular cortex in panoramic radiograph in post menopausal women.
To assess the bone mineral density of lumbar spine using DEXA (dual energy X-ray absorptiometry)
To analyze the usefulness of visual assessment of mandibular cortex in panoramic radiographs as an indicator of low bone mineral density.
b) MATERIALS AND METHODS
SOURCE OF DATA
30 postmenopausal women from outpatient Department of Oral Medicine and Radiology, Dayananda Sagar College of Dental Sciences.
METHOD OF COLLECTION OF DATA
SAMPLE SIZE:
30 postmenopausal women will be selected according to Specified criteria.
SAMPLING METHOD: RANDOM SAMPLING.
STUDY DESIGN: COHORT STUDY.
METHODOLOGY:
30 women with confirmed menopausal status will be subjected to panoramic radiographs with informed consent. The radiographs will be obtained at 12mA and 15 seconds; the KV varied between 70 & 80.processing will be done manually according to manufacturer’s instructions. On same patients BMD assessment of lumbar spine at T3-T4 level will be done using dual energy X-ray absorptiometry.
Three oral radiologists & one general practitioner will be assessing the films. Observers will rate the mandibular inferior cortex accordingly as thin or not thin.
At the same time, measurement of mandibular cortical width will be made by another Oral radiologist, bilaterally on the radiographs at the site of mental foramen using callipers.
The observations will be analyzed statistically.
INCLUSION CRITERIA
All subjects included will not have previous diagnosis of osteoporosis.
Subjects with confirmed menopausal status.
EXCLUSION CRITERIA
Subjects with following metabolic disease to be excluded: Hyperparathyroidism, Hypoparathyroidism, Paget’s disease, Osteomalacia, Renal osteodystrophy, Osteogenesis imperfecta.
Cancers with bony metastasis.
Significant renal impairment.
Any medication that affects bone metabolism e.g. oestrogen.
History of smoking or any bone destructive lesion (e.g. malignant tumor or osteomyelitis)
Does the study require any investigations or interventions to be conducted on patients or other human or animals? If so, please describe briefly.
YES, panoramic radiographs and DEXA (dual energy X-ray absorptiometry) will be done on women patients with informed consent.
Has ethical clearance been obtained by your institution?
YES
c)REFERENCES
1)Kaoru lee,Akira Taguchi,Kodo Ishii:Visual assessment of mandibular cortex on panoramic radiographs to identify postmenopausal women with low bone mineral density.Oral Surgery Oral Med Oral Pathol Oral Radiol Endod 2005;100:26-31.
2)Kalender WA,Klotz E.Suess C:Vertebral bone mineral: An integrated approach with CT.Radiology1987;164:419-23.
3)A.Taguchi,Y.Suei,M.Ohtsuka: Usefulness of panoramic radiography in the diagnosis of postmenopausal osteoporosis in women.Dentomaxillofac.radiol,1996;225:263-67.
4)Klementti E,Kolmakov S Kroger H: Pantomography in assessment of the osteoporosis risk group. Scand J Dent Res 1994:102:68-72
5)Bollen AM,Taguchi A,Hujoel PP,Hollender LG: Case control study on self reported osteoporotic fractures and mandibular cortical bone. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:518-24.
6)Devlin H,Horner K: Mandibular radiomorphometric indices in the diagnosis of reduced skeletal bone mineral density.Osteoporos Int 2002;13:373-8.