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

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Abstract

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.

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Acknowledgments

We thank Dr. Grethe Jonasson for providing her panoramic images regarding the classification of the alveolar trabecular bone pattern of the mandible. The research was supported in part by the Japan Society for the Promotion of Science Grants-in-Aid for Scientific Research (A.T.: Grant nos. 18K09758 and 18H04069). We thank Edanz Group (https://en-author-services.edanz.com/ac) for editing a draft of this manuscript.

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The research was supported in part by a grant from the Japanese Dental Science Federation (JDSF-DSP2-2017-000-1).

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Akira Taguchi received a retaining fee from MEDIA Co. Ltd (Tokyo, Japan). Akitoshi Katsumata received research funding from MEDIA Co. Ltd (Tokyo, Japan). Ray Tanaka, Naoya Kakimoto, Yasuhiro Morimoto, Yoshinori Arai, Takafumi Hayashi, Tohru Kurabayashi, and Junichi Asaumi have no conflicts of interest.

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Taguchi, A., Tanaka, R., Kakimoto, N. et al. Clinical guidelines for the application of panoramic radiographs in screening for osteoporosis. Oral Radiol 37, 189–208 (2021). https://doi.org/10.1007/s11282-021-00518-6

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