Panoramic Mandibular Index Detected Osteoporosis at 0.89 AUC in Small DXA Study

Edited by Dentaltown staff

Mandibular indices measured on routine panoramic radiographs and cone beam computed tomography scans separated postmenopausal women with osteoporosis from those with normal bone density, according to a study published online Sept. 11 in Hormones.

Seventy postmenopausal women underwent panoramic radiography, CBCT, and dual-energy X-ray absorptiometry, the clinical reference standard for bone mineral density. An oral surgeon certified in oral radiology evaluated the images.

Four indices were assessed on the panoramic images: the Mandibular Cortical Index, Mental Index, Panoramic Mandibular Index, and Molar Index. Corresponding CT-based versions of each were derived from the CBCT measurements.

Three performed best. For distinguishing women with normal bone density from those with osteoporosis, the Panoramic Mandibular Index reached an area under the curve of 0.89, with a 95% confidence interval of 0.77 to 1.00. Its CBCT counterpart reached 0.88, and the Molar Index 0.86.

The authors proposed optimal cutoff values of approximately 3.5 to 4.0 for the Mental Index and its CT equivalent, 0.32 to 0.38 for the Panoramic Mandibular Index and its CT equivalent, and 3.1 to 3.35 for the Molar Index.

Accuracy was better at separating normal from osteoporotic patients than at identifying osteopenia, the intermediate stage of bone loss.

Argyris Dimitrios Kouramas and Sokratis Varitimidis of the University of Thessaly conducted the study with Antigoni Delantoni of the Aristotle University of Thessaloniki School of Dentistry and Theodoros Petsas of the University Hospital of Patras.

The cohort was small, and the confidence intervals around the strongest estimates extended to 1.00. The authors positioned the indices as a way to identify women who might benefit from referral for DXA assessment rather than as a substitute for it.

Sources:
Hormones, “Opportunistic screening for osteoporosis using dental radiographic indices,” published online Sept. 11, 2026: doi.org/10.1007/s42000-026-00820-0