The role of the dental surgeon in detecting osteoporosis: the OSTEODENT study

Objective To determine if thinning (< 3 mm width) of the lower cortical border of the mandible on dental panoramic radiographs, as well as other clinical risk factors, may provide a useful diagnostic test for osteoporosis in young postmenopausal women. Design Six hundred and fifty-two subjects ( age range 45-70 years) were involved in this multi-centre, cross-sectional study. Setting Patients were recruited from centres in Leuven ( Belgium), Athens ( Greece), Manchester (UK), and Malmo ( Sweden). Subjects and methods The subject's age, body weight, whether the patient took hormone replacement therapy or had a history of low trauma fracture were used to form a clinical osteoporosis risk assessment ( the OSteoporosis Index of RISk or OSIRIS index). Each patient also received a dental panoramic radiographic examination. Results One hundred and forty subjects had osteoporosis involving at least one of the measurement sites ( lumbar spine, femoral neck or total hip). Those with osteoporosis tended to have a low OSIRIS score and a thinned cortical mandibular border. The area under the ROC curve for using both cortical width and OSIRIS to predict osteoporosis was 0.90 ( 95% CI = 0.87 to 0.92). There was a significant improvement in the diagnostic ability of the combined OSIRIS and cortical width test over both tests applied separately ( p < 0.001). The cost effectiveness of the cortical width and OSIRIS model was improved by using a high specificity threshold rather than high sensitivity. However, this analysis ignores the costs associated with missed cases of osteoporosis. Conclusion Dentists have a role to play in the detection and referral of patients at high risk of osteoporosis.