Diagnosis of osteoporosis in dental patients

Osteoporosis is a severe skeletal disease that leads to bone fractures, even disability, if it remains undetected. However, osteoporosis remains frequently unnoticed until a fracture occurs. It is possible for dental practitioners to screen patients at risk of osteoporosis and refer them for an osteoporosis evaluation. Screening can be achieved mainly through dental radiographs and especially panoramic x-rays, where several radiographic indices, such as Mandibular Cortical Width (MCW), Mandibular Cortical Index (MCI), Gonial Index (GI), Antigonial Index (AI), Panoramic Mandibular Index (PMI) and alveolar crest resorption degree (M/M ratio) can be assessed. Furthermore, patients with osteoporosis develop changes in the trabecular bone of their jaws and those alternations can be detected by dentists through periapical and panoramic x-rays. Moreover, periodontitis, which is a major reason for tooth loss, deteriorates when the patient also suffers from osteoporosis. Dentists can thus screen their patients who are possibly unaware of their osteoporosis, and refer them further for dual-energy X-ray absorptiometry (DXA) examination. However, all the above indices are merely indicative of low skeletal bone mineral density and the dentist must always take into account the medical history and clinical risk factors of osteoporosis before further referring to an osteoporosis specialist.