Clinical guidelines for the application of panoramic radiographs in screening for osteoporosis

Osteoporotic fractures are associated with an increased risk of subsequent fractures, a higher rate of mortality, and incremental medical costs. Incidental findings, which include some measurements related to the mandibular inferior cortex and the alveolar trabecular bone pattern of the mandible determined on panoramic radiographs, are considered to be a useful tool for identifying asymptomatic individuals at risk of having osteoporosis and/or fragility fractures. We undertook a worldwide literature survey and present the following clinical recommendations. Postmenopausal female dental patients with a mandibular inferior cortical width of less than 3 mm on panoramic radiographs may be at risk of having low skeletal bone mineral density (BMD) or osteoporosis, but not fragility fractures. In addition, those with a severely eroded mandibular inferior cortex may have an increased risk of having low skeletal BMD, osteoporosis, and fragility fractures. The alveolar trabecular bone pattern of the mandible might be useful for identifying female dental patients at risk of having fragility fractures, although further investigation is necessary to confirm this possibility. These incidental findings on panoramic radiographs, when used for identifying asymptomatic postmenopausal female patients at risk of having osteoporosis in general dental practice, may be helpful in reducing the incidence of first fractures, with a consequent reduction in the secondary fractures, medical costs, and mortality associated with osteoporotic fragility fractures, without incurring any additional cost.

Automated summary

Osteoporotic fractures pose increased risks of subsequent fractures, mortality, and medical costs. Incidental findings on panoramic radiographs, such as measurements related to the mandibular inferior cortex and alveolar trabecular bone pattern, can be useful in identifying asymptomatic individuals at risk of osteoporosis and fragility fractures, particularly postmenopausal females. Clinical recommendations suggest that measurements of mandibular inferior cortical width and alveolar trabecular bone pattern are potential indicators of low skeletal bone mineral density, osteoporosis, and fragility fractures. Use of these findings in general dental practice may help reduce the incidence of first fractures and subsequent medical costs and mortality associated with osteoporotic fragility fractures.