Osteoporosis 2013 July-3


Mandibular bone changes in 24 years and skeletal fracture prediction.

Clin Oral Investig. 2013 Mar;17(2):565-72.

Jonasson G, Sundh V, Hakeberg M, Hassani-Nejad A, Lissner L, Ahlqwist M.

Research and Development Unit, Southern Älvsborg County, Sven Eriksonplatsen 4, 503 38 Borås, Sweden. grethe.jonasson@vgregion.se


OBJECTIVES: The objectives of the investigation were to describe changes in mandibular bone structure with aging and to compare the usefulness of cortical and trabecular bone for fracture prediction.

MATERIALS AND METHODS: From 1968 to 1993, 1,003 women were examined. With the help of panoramic radiographs, cortex thickness was measured and cortex was categorized as: normal, moderately, or severely eroded. The trabeculation was assessed as sparse, mixed, or dense.

RESULTS: Visually, the mandibular compact and trabecular bone transformed gradually during the 24 years. The compact bone became more porous, the intertrabecular spaces increased, and the radiographic image of the trabeculae seemed less mineralized. Cortex thickness increased up to the age of 50 and decreased significantly thereafter. At all examinations, the sparse trabeculation group had more fractures (71-78 %) than the non-sparse group (27-31 %), whereas the severely eroded compact group showed more fractures than the less eroded groups only in 1992/1993, 24 years later. Sparse trabecular pattern was associated with future fractures both in perimenopausal and older women (relative risk (RR), 1.47-4.37) and cortical erosion in older women (RR, 1.35-1.55). RR for future fracture associated with a severely eroded cortex increased to 4.98 for cohort 1930 in 1992/1993. RR for future fracture associated with sparse trabeculation increased to 11.43 for cohort 1922 in 1992/1993.

CONCLUSION: Dental radiographs contain enough information to identify women most at risk of future fracture.

CLINICAL RELEVANCE: When observing sparse mandibular trabeculation, dentists can identify 40-69 % of women at risk for future fractures, depending on participant age at examination.

PMID: 22547324


Grethe Jonasson-rGrethe Jonasson-mGrethe Jonasson-1










Fig. 1 Reference images (panoramic radiographs) presenting dense trabeculation and a normal mandibular cortex with even and sharp endosteal margin (left), mixed trabeculation and a moderately eroded cortex with endosteal margin showing semilunar defects (middle), and sparse trabeculation and severely eroded cortex with cortical layer being clearly porous (right).

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